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Revised Cardiac Risk Index of Lee et al for Patients Undergoing Noncardiac Surgery

Purpose: To evaluate a patient before noncardiac surgery using the revised cardiac risk index.

Description

The risk of a major cardiac complication occurring in association with nonemergency, noncardiac surgery can be estimated using the revised cardiac risk index. The study was done at Brigham and Women's Hospital and the University of California at San Francisco.


(1) riskiness of surgery

(2) history of ischemic heart disease

(3) history of congestive heart failure

(4) history of cerebrovascular disease

(5) diabetes mellitus

(6) renal function and serum creatinine level

 

Parameter

Finding

Points

riskiness of surgery

low or moderate risk

0

 

high risk

1

ischemic heart disease

absent

0

 

present

1

congestive heart failure

absent

0

 

present

1

cerebrovascular disease

absent

0

 

present

1

insulin-dependent diabetes mellitus

absent

0

 

present

1

serum creatinine

<= 2mg/dL

0

 

> 2 mg/dL

1

 

where:

• High risk surgery includes abdominal aortic aneurysm repair, thoracic surgery or major intrabdominal operation.

• Ischemic heart disease includes previous myocardial infarction, angina, history of positive exercise test, presence of Q waves.

• Cerebrovascular disease includes a history of stroke or transient ischemic attack (TIA).

 

risk score =

= SUM(points for the 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 6

• Patients with 2 or more risk factors benefit from improved perioperative management.

 

Risk Score

Risk of Major Cardiac Complication

0

0.4%

1

1.1%

2

4.6%

>= 3

9.7%

 

Major cardiac complications include:

(1) myocardial infarction

(2) cardiogenic pulmonary edema

(3) ventricular fibrillation

(4) primary cardiac arrest

(5) complete heart block


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Specialty

Objective

ICD-10