Estimate perioperative major adverse cardiac event (MACE) risk before non-cardiac surgery.
When to use: Apply RCRI in the preoperative assessment of adults undergoing elective non-cardiac surgery to estimate major adverse cardiac event risk. RCRI ≥3 warrants cardiology referral and optimisation before proceeding. It also informs the decision to obtain preoperative cardiac testing (stress test, echocardiogram) and whether beta-blocker continuation or initiation is appropriate.
Score 0 = 3.9%, 1 = 6%, 2 = 10.1%, ≥3 = ≥15% MACE risk — these numbers are directly tested in anaesthesia/surgery MCQs.
Beta-blockers: continue if patient is already on them; do NOT initiate on the day of surgery (worsens outcomes) — start 1–2 weeks before if indicated.
ACC/AHA guidelines: functional capacity ≥4 METs (can climb one flight of stairs or walk on level ground at 4 mph) is reassuring — proceed without further cardiac testing.
References
Lee TH et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery · Circulation (1999)
Fleisher LA et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery · J Am Coll Cardiol (2014)
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