The Revised Cardiac Risk Index (RCRI) and the National Surgical Quality Improvement Program (NSQIP) index
| RCRI1 | NSQUIP2 | |
|---|---|---|
| Factors used | History of ischemic heart disease | Age |
| History of heart failure | Serum creatinine > 1.5 mg/dL | |
| History of cerebrovascular disease | American Society of Anesthesiology (ASA) class | |
| Insulin-dependent diabetes | Functional status | |
| Preoperative serum creatinine > 2.0 mg/dL | Type of surgery | |
| Undergoing suprainguinal vascular, intraperitoneal, or intrathoracic surgery | ||
| Interpretation | Low risk risk factors: 0.4% risk risk factor: 0.9% risk | Web-based calculator gives a percent risk: www.qxmd.com/calculate/calculator_245/gupta-perioperative-cardiac-risk |
| Elevated risk | ||
| 2 risk factors: 7% risk | ||
| > 3 factors: 11% risk | ||
| Derivation and validation study design | Prospective cohort 1989-1994 | Historical national database 2007-2008 |
| Single hospital 5,737 patients > age 50 | Multicenter (200 hospitals) 46,8795 patients > 16 years old | |
| Outcomes assessed | Myocardial infarction | Myocardial infarction, defined as 1 of the following: ST-segment elevation |
| Cardiac arrest | New Q waves | |
| Ventricular fibrillation | New left bundle branch block | |
| Pulmonary edema | Troponins > 3 times normal | |
| Complete heart block | Cardiac arrest | |
| Advantages | Used for more than a decade | Surgery-specific |
| Disadvantages | Advanced laparoscopic procedures were not widely performed when this index was devised | Coronary artery disease, aortic stenosis are not variables |
| Functional capacity not a variable Definition of myocardial infarction is based on creatine kinase MB (CK-MB): CK-MB > 5% of total CK, or > 3% of total CK with electrocardiographic changes | Myocardial infarctions may have been overdiagnosed due to troponin elevation of unknown significance | |
| Only 0.2% patients had severe aortic stenosis, so it is not included | ||