Revised Cardiac Risk Index (RCRI)

Six criteria, each worth one point. The count gives a class, and the class carries a published event rate. Read each definition before you tick it, because the paper defines the criteria more narrowly than the short labels suggest. The derivation cohort rate and the validation cohort rate are both shown, because they disagree.

Age

years

The index has no age term. The age labels the result. Read the cohort description below.

Tick each criterion that is present

Read the definition under each label. The definitions are narrower than the labels.

High-risk surgeryIntraperitoneal, intrathoracic, or suprainguinal vascular procedures.Ischemic heart diseaseHistory of myocardial infarction, a positive exercise test, current chest pain considered secondary to myocardial ischemia, use of nitrate therapy, or an ECG with pathological Q waves. A previous bypass or angioplasty counts only where there is current ischemic chest pain.Congestive heart failureHistory of congestive heart failure, pulmonary edema, or paroxysmal nocturnal dyspnea; bilateral rales or an S3 gallop on examination; or pulmonary vascular redistribution on the chest radiograph.Cerebrovascular diseaseA history of transient ischemic attack or stroke.Insulin therapy for diabetesPreoperative treatment with insulin for diabetes mellitus.Serum creatinine above 2.0 mg/dLPreoperative serum creatinine greater than 2.0 mg/dL.

Enter an age above zero. Then tick each criterion that is present to see the score, the class, and the two published event rates.

What this index reports

Major cardiac complication in hospital: myocardial infarction, pulmonary edema, ventricular fibrillation or primary cardiac arrest, and complete heart block.

How well it discriminates

Area under the receiver operating characteristic curve 0.759 in the derivation cohort and 0.806 in the validation cohort. Applied later to the 2008 NSQIP data set the area was 0.747 across all surgery and 0.591 in aortic and other noncardiac vascular surgery.

Not the same outcome as the Gupta MICA cardiac risk score

The two scores predict different outcomes over different time windows. Do not compare the two percentages directly. Open the other score to read its own outcome and its own numbers.

Gupta MICA cardiac risk

What this index assumes

The event rates are observed rates in the published cohorts, not a model output, and they are not adjusted for this patient.
The derivation and the validation cohort disagree, most of all at class III, where the rates are 3.6 percent and 6.6 percent. Both are shown and neither is averaged.
The cohort was patients aged 50 and over having nonemergent major noncardiac surgery with an expected stay of at least two days, at one hospital, between 1989 and 1994.
The authors state the index is of uncertain generalizability to minor procedures and to emergencies, and it showed no relationship to outcome in abdominal aortic aneurysm surgery in the same paper.
The outcome is not the same outcome as the Gupta MICA model. Do not compare the two percentages directly.