Anaes · Vascular anaesthesia
Perioperative cardiac risk: Revised Cardiac Risk Index (RCRI)
Also known as Perioperative cardiac risk: Revised Cardiac Risk Index (RCRI)
Exam-exhaustive Revised Cardiac Risk Index: exact six predictors, original risk bands, limitations, functional capacity, further testing principles, and POISE beta-blockade caution for ANZCA Final and equivalent viva/SAQ surfaces.
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Target exams
Red flags
- RCRI has exactly six equal-weight predictors.
- High-risk surgery: intraperitoneal, intrathoracic, or suprainguinal vascular.
- Insulin-treated diabetes is the diabetes criterion.
- Creatinine >2 mg/dL (177 µmol/L).
- POISE: do not start high-dose beta-blockade naively on the day of surgery.
Meet the patient
A 72-year-old man is booked for elective open abdominal aortic aneurysm repair. He had a myocardial infarction two years ago, his diabetes is diet-controlled, and his creatinine is 190 micromoles per litre. He can climb one flight of stairs, slowly. On the preadmission round the registrar asks whether to start metoprolol 200 mg in the morning to protect his heart.[1][2]
Two questions decide his day, and they are the two every RCRI stem turns on: how many of the six points does he carry, and what does POISE say about that beta-blocker idea? Hold those two and the whole topic slots into place.[1]
References4ShowHide
- [1]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528
- [2]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial Lancet, 2008.PMID 18479744
- [3]Lewis SC, Warlow CP, Bodenham AR, et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial Lancet, 2008.PMID 19041130
- [4]Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Circulation, 2024.PMID 39316661