Systematic review of performance of the Revised Cardiac Risk Index

January 01, 0001

Systematic review of performance of the Revised Cardiac Risk Index

These Canadian authors evaluated the ability of the Revised Cardiac Risk Index (RCRI) to predict cardiac complications and death after noncardiac surgery. They included cohort studies that reported the association of the RCRI with major cardiac complications (cardiac death, myocardial infarction, and nonfatal cardiac arrest) or death in the hospital or within 30 days of surgery.

They found: “Of 24 studies (792 740 patients), 18 reported cardiac complications, 6 of the 18 studies were prospective and had uniform outcome surveillance and blinded outcome adjudication. The RCRI discriminated moderately well between patients at low versus high risk for cardiac events after mixed noncardiac surgery (area under the receiver-operating characteristic curve {AUC} 0.75), sensitivity 0.65, specificity 0.76, positive likelihood ratio 2.78, negative likelihood ratio 0.45). Prediction of cardiac events after vascular noncardiac surgery was less accurate (AUC 0.64, sensitivity 0.70, specificity 0.55, positive likelihood ratio 1.56, negative likelihood ratio 0.55). Six studies reported death, with a median AUC of 0.62 (range, 0.54 to 0.78). A pooled AUC for predicting death could not be calculated because of very high heterogeneity.”

 The authors concluded: “The RCRI discriminated moderately well between patients at low versus high risk for cardiac events after mixed noncardiac surgery. It did not perform well at predicting cardiac events after vascular noncardiac surgery or at predicting death. High-quality research is needed in this area of perioperative medicine.”

Better tools should be developed to predict perioperative cardiovascular risk.


For the full abstract, click here.

Annals of Internal Medicien 152(1):26-35, 5 January 2010. © 2010 to the American College of Physicians.
Systematic Review-Prediction of Perioperative Cardiac Complications and Mortality by the Revised Cardiac Risk Index. Meredith K. Ford, W. Scott Beattie and Duminda N. Wijeysundera. Correspondence to Dr. Wijeysundra: [email protected]

Category: K. Circulatory. Keywords: noncardiac surgery, vascular surgery, risk prediction, Revised Cardiac Risk Index, systematic review of cohort studies
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 26 January 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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