RCRI Perioperative Risk Assessment — EECC MCQ

Correct answer: B — An RCRI score ≥3 predicts a high risk of perioperative major adverse cardiac events (>5%); functional capacity assessment and consideration of preoperative cardiac optimisation are warranted

The Revised Cardiac Risk Index (RCRI/Lee Index) is a validated tool for predicting perioperative MACE in non-cardiac surgery. It assigns 1 point each for: (1) high-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular); (2) ischaemic heart disease; (3) congestive heart failure; (4) cerebrovascular disease; (5) diabetes on insulin; (6) creatinine >177 micromol/L. Risk: 0 points = ~3.9% MACE; 1 = ~6.0%; 2 = ~10.1%; ≥3 = ~15%. This patient (IHD + HF + major surgery = 3 points) is high-risk. The ESC 2022 Non-cardiac Surgery Guidelines recommend: (1) RCRI as the initial risk assessment; (2) functional capacity assessment (>4 METs without symptoms = favourable); (3) biomarker-based risk stratification (NT-proBNP, troponin); (4) optimisation of cardiac medications preoperatively.

Reference: ESC (2022): Guidelines on Non-cardiac Surgery