Key result
Revised Cardiac Risk Index shows modest accuracy for predicting 30-day MACE after elective non-cardiac surgery.
Why the study?
The optimal strategy for preoperative cardiac risk assessment remains unclear, with conflicting international guidelines on the use of predictive tools and tests.
Does the Revised Cardiac Risk Index accurately predict major adverse cardiac events in patients undergoing elective non-cardiac surgery?
Cohort (n=1,465)
No
Does the Revised Cardiac Risk Index accurately predict major adverse cardiac events in patients undergoing elective non-cardiac surgery?
Effect estimate: AUC 0.73 (95% CI 0.60-0.86)
The Revised Cardiac Risk Index has only modest predictive value for early cardiac complications after elective non-cardiac surgery in a contemporary Australian cohort, though scores of 2 or more indicate elevated risk.
RCRI should not guide perioperative decisions alone; leaves open validation of refined risk models in contemporary elective surgery cohorts.
Clinicians assessing cardiac risk as part of a comprehensive consultation before surgery can use an expanding set of tools, including predictive risk calculators, cardiac stress tests and measuring serum natriuretic peptides. The optimal assessment strategy is unclear, with conflicting international guidelines. We investigated the prognostic accuracy of the Revised Cardiac Risk Index for risk stratification and cardiac outcomes in patients undergoing elective non-cardiac surgery in a contemporary Australian cohort. We audited the records for 1465 consecutive patients 45 years and older presenting to the perioperative clinic for elective non-cardiac surgery in our tertiary hospital. We calculated individual Revised Cardiac Risk Index scores and documented any use of preoperative cardiac tests. The primary outcome was any major adverse cardiac events within 30 days of surgery, including myocardial infarction, pulmonary oedema, complete heart block or cardiac death. Myocardial perfusion imaging was the most common preoperative stress test (4.2%, 61/1465). There was no routine investigation of natriuretic peptide levels for cardiac risk assessment before surgery. Major adverse cardiac events occurred in 1.3% (18/1366) of patients who had surgery. The Revised Cardiac Risk Index score had modest prognostic accuracy for major cardiac complications, area under receiver operator curve 0.73, 95% confidence interval 0.60 to 0.86. Stratifying major adverse cardiac events by the Revised Cardiac Risk Index scores 0, 1, 2 and 3 or greater corresponded to event rates of 0.6% (4/683), 0.8% (4/488), 4.1% (6/145) and 8.0% (4/50), respectively. The Revised Cardiac Risk Index had only modest predictive value in our single-centre experience. Patients with a revised cardiac risk index score of 2 or more had an elevated risk of early cardiac complications after elective non-cardiac surgery.
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Yao et al. (2021) conducted a cohort in Elective non-cardiac surgery (n=1,465). Revised Cardiac Risk Index was evaluated on Major adverse cardiac events within 30 days of surgery, including myocardial infarction, pulmonary oedema, complete heart block or cardiac death (AUC 0.73, 95% CI 0.60-0.86). The Revised Cardiac Risk Index demonstrated modest prognostic accuracy for predicting major adverse cardiac events within 30 days of elective non-cardiac surgery (AUC 0.73; 95% CI 0.60-0.86).
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