The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Abstract

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients L'indice de risque cardiaque modifié dans le nouveau millénaire: une réévaluation prospective et unicentrique de cohorte des variables originales chez 9519 patients consécutifs devant subir une chirurgie non urgente Abstract Purpose Cardiac complications following non-cardiac surgery are major causes of morbidity and mortality. The Revised Cardiac Risk Index (RCRI) has become a standard for predicting post-surgical cardiac complications. This study re-examined the original six risk factors to confirm their validity in a large modern prospective database.Methods Using the definitions in the original risk index, this study included 9,519 patients aged C 50 undergoing elective non-cardiac surgery with an expected length of stay C two days at two major tertiary-care teaching hospitals. The validity of the original predictors was tested in this population using binomial logistic regression modelling, area under the receiver operator curve (ROC) analysis, and the net reclassification index. Results Rates of major cardiac complications with 0, 1, 2, C 3 of the predictors were 0.5%, 2.6%, 7.2%, and 14.4%, respectively, in our patient cohort compared with 0.4%, 1.1%, 4.6%, and 9.7%, respectively, in the original cohort. Similar to the original report, binary logistic regression analysis showed that both preoperative treatment with insulin (odds ratio [OR] 1.4; 95% confidence interval [CI] 0.7 to 2.6) and preoperative creatinine [ 176.8 mmolÁL -1 (OR 1.7; 95% CI 0.8 to 3.6) did not improve the predictive ability of the index. Analysis of the remaining four factors resulted in an area under the curve (AUC) identical to that seen for the reconstructed six-factor RCRI (AUC = 0.79). We found that a Author contributions Christopher Davis organized and performed the analysis, wrote the first draft of the manuscript, and was responsible for major revisions to both the analysis and manuscript. Gordon Tait was responsible for creation of the database and the data integrity. He performed and or supervised quality checks on the data and helped perform the data analysis. Gordon Tait, Jo Carroll, and Duminda N. Wijeysundera made key revisions to the manuscript. Jo Carroll assisted in the creation of the database and quality control of the data. Duminda N. Wijeysundera and W. Scott Beattie were responsible in part for the concept of the study. Duminda N. Wijeysundera revised key aspects of the data analysis. W. Scott Beattie was responsible in part for supervision of the project. He obtained funding for the project, helped write all drafts of the manuscript, and made revisions to the data analysis. Dr. Beattie was Mr. Davis's summer elective supervisor. All authors have seen the data analysis and the revised manuscript and vouch for the authenticity of all aspects of this manuscript. glomerular filtration rate (GFR) \ 30 mLÁmin -1 was a better predictor of major...

Prediction Score in Surgical Complications Estimation in the Practice of Internist

“…Частота развития возможных ССО при наличии 0 баллов составляет 0,4%, 1 балла -0,9%, 2 баллов -6,6%, ≥3 баллов -11% [2,4]. В настоя-щее время в литературе описывается еще один вари-ант модификации шкалы RCRI, в котором функция почек оценивается не по уровню креатинина, а по расчету скорости клубочковой фильтрации, а также исключен сахарный диабет, как один из оце-ниваемых факторов [8]. Такая модификация кальку-лятора не вошла в имеющиеся рекомендации по оценке предоперационного риска, однако в даль-нейшим может широко войти в клиническую прак-тику [9].…”

The criteria of “inoperability”

“…While it allows for good discrimination between patients with varying risks of cardiac complications, however, the index is a poor predictor of postoperative mortality [6]. In addition, some of its components, such as diabetes mellitus, may warrant elimination, as they provide minimal associated prognostic information [7].…”

Perioperative assessment of troponin level in the non-cardiac interventions: is there such a need?

“…Поэтому в качестве альтернативы шкале RCRI предло-жено использовать другие шкалы оценки риска [2,3]: NSQIP MICA [40], калькулятор хирургического риска ACS NSQIP [41], реконструированный RCRI [42]. Общим не-достатком всех приведенных шкал является то, что они не учитывают риск у пациентов с бессимптомным течением заболевания.…”