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The RCRI estimates the risk of 30 day mortality, MI, or cardiac arrest, and is based on six variables.46,47 It has been validated in several countries and is easy to use.47 A score of 0 indicates a 4% risk of 30 day mortality, MI, or cardiac arrest; a score of 1 indicates a 6% risk; a score of 2, 10%; and a score of ≥3, 15%.47

The American College of Surgery National Surgical Quality Improvement Program (ACS NSQIP) developed an interactive risk

Table 6 Risk score calculators

Revised Cardiac Risk Index (RCRI)

(1999)a Surgical Risk

Calculator (2011) The American College

of Surgery National Surgical Quality Improvement Program

(ACS NSQIP) (2013) Surgical

Outcome Risk Tool (SORT) (2014) The American

University of Beirut (AUB)-HAS2 Cardiovascular Risk

Index (2019)b

Variables Ischaemic heart

disease Cerebrovascular disease History of congestive heart failure Insulin therapy for diabetes Serum creatinine level ≥2 mg/dL High-risk surgery (each assigned 1 point) Age

ASA–PS grade Pre-operative dependent functional status Creatinine .1.5 mg/dL Type of surgery Age

Sex Functional status Emergency case ASA class Current steroid use Ascites within 30 days Systemic sepsis within 48 h Ventilator dependence Disseminated cancer Diabetes Hypertension on treatment Congestive HF Dyspnoea Current smoker History of severe COPD Dialysis Acute renal failure Body mass index Surgery code ASA–PS grade

Urgency of surgery High-risk surgical specialty Surgical severity (from minor to complex major) Cancer Age ≥65 years or over History of Heart disease

Symptoms of Heart disease (angina or dyspnoea) Age ≥75 years Anaemia (haemoglobin ,12 g/dL) Vascular Surgery Emergency Surgery (2 H, 2 A and 2 S) (each assigned 1 point)

Score range Score 1; risk 6.0%

(4.9–7.4) Score 2; risk 10.1% (8.1–10.6) Score ≥3; risk 15% (11.1–20.0) Absolute risk: 0–100% Absolute risk: 0–100% Absolute risk:

0–100% Low risk (score 0–1); (0.3

and 1.6%)c Intermediate risk (score 2– 3); (7.1 and 17%)c High risk (score .3); (.17%)c

Outcome 30 day MI, cardiac

arrest, death Intra-operative and 30

day MI or cardiac arrest Serious complications and

any complications at 30 days 30 day

mortality 30 day death, MI, or stroke

Derivation population 1422 211 410 1 414 006 11 219 3284 Validation population Externally validated in

various surgical populations 257 385 Externally validated in

various surgical populations 22 631 1 167 414

Model performance (AUC) 0.68–0.76 0.81–0.85 0.73 0.81–0.92 0.82 Interactive calculator https://www.mdcalc.

com/revised-cardiacrisk-index-preoperative-risk http://www.

surgicalriskcalculator. com/miorcardiacarrest https://riskcalculator.facs.

org http://www.

sortsurgery. com © ESC 2022

AUC, area under curve; ASA–PS, American Society of Anesthesiology Physical Status; COPD, chronic obstructive pulmonary disease; HF, heart failure; MI, myocardial infarction; RCRI, Revised Cardiac Risk Index. aThe RCRI was updated January 2019. bDakik et al. 2019, 2020, and 2022, and Msheik et al.49–51,81 cThe percentages relate to general surgeries.50 Downloaded from academic.oup.com/eurheartj/article/43/39/3826/6675076 by guest on 07 October 2026