## Revised Cardiac Risk Index (RCRI) — The Six Predictors **Key Point:** The RCRI, developed by Lee et al. (1999), identifies six independent predictors of major adverse cardiac events (MACE) in non-cardiac surgery via multivariate analysis. Age > 70 years is **NOT** one of these six predictors. ### The Six RCRI Predictors | Predictor | Details | |-----------|---------| | **High-risk type of surgery** | Suprainguinal vascular, intrathoracic, intraperitoneal | | **History of ischemic heart disease** | MI, angina, positive stress test, nitrate use | | **History of congestive heart failure** | Clinical or radiological evidence | | **History of cerebrovascular disease** | Stroke, TIA | | **Preoperative serum creatinine > 2 mg/dL** | Marker of renal dysfunction | | **Insulin-dependent diabetes mellitus** | Preoperative insulin therapy | **High-Yield:** **Age > 70 years** is NOT an independent predictor in the RCRI. Although age is a univariate risk factor for cardiac events, it did not remain statistically independent after multivariate adjustment in Lee's original derivation cohort. This is a classic exam trap — age appears in other risk models (e.g., Goldman index) but was deliberately excluded from the RCRI. **Clinical Pearl:** Options A (cerebrovascular disease), C (creatinine > 2 mg/dL), and D (insulin-dependent DM) are all genuine RCRI predictors. Option B (Age > 70 years) is the only option that is NOT part of the RCRI. **RCRI Scoring:** 0 points ≈ 0.4% risk; 1 point ≈ 0.9%; 2 points ≈ 7%; ≥3 points ≈ 11% risk of major cardiac complications [Lee et al., Circulation 1999; Harrison's Principles of Internal Medicine, 21e, Ch. 47]. **Mnemonic (CHIC-RI):** **C**erebrovascular disease, **H**eart failure, **I**schemic heart disease, **C**reatinine > 2 mg/dL, **R**isk surgery (high-risk), **I**nsulin-dependent DM — Age is NOT included.
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