Clinical Report: Association of the Revised Cardiac Risk Index with 90-Day Mortality

Overview

This study evaluates the association between Revised Cardiac Risk Index (RCRI) scores and 90-day all-cause mortality in a cohort of 54,933 patients undergoing non-cardiac surgery. Higher RCRI scores are linked to increased mortality risk.

Background

The Revised Cardiac Risk Index (RCRI) is a tool for predicting major cardiac complications post-surgery. Understanding its relationship with 90-day all-cause mortality is essential, as this timeframe provides a comprehensive assessment of surgical risk, particularly for patients with multiple comorbidities. This study investigates the association between RCRI and 90-day mortality in non-cardiac surgical populations.

Data Highlights

Key Findings

• 1.3% of patients (735) died within 90 days postoperatively.
• Higher RCRI classes correlate with significantly poorer survival rates (log-rank p < 0.001).
• Hazard ratios for 90-day mortality increase with higher RCRI scores: Class II (1.97), Class III (1.93), Class IV (3.08).
• Subgroup analyses confirm consistent associations across various demographics and surgical priorities.
• RCRI is effective for preoperative risk stratification in diverse surgical populations.

Clinical Implications

The findings suggest that RCRI scores may be considered when assessing preoperative risk in patients undergoing non-cardiac surgery.

Conclusion

The study demonstrates an association between higher RCRI scores and increased 90-day mortality.

Related Resources & Content

1. Yilin Eileen Sim et al., Frontiers in Cardiovascular Medicine, 2026 -- The Revised Cardiac Risk Index and 90-Day Mortality After Non-Cardiac Surgery
2. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery, JACC, 2024
3. Association of the Revised Cardiac Risk Index with 1-year postoperative mortality: A single-center retrospective study, ScienceDirect, 2025
4. Perioperative Complications Linked to Negative Long-Term Outcomes and Influence on Mortality Following General Surgery
5. Clinical Research in Cardiology — Prognostic Significance of High-Sensitivity Cardiac Troponin I Following Non-CABG Cardiac Surgery
6. Evaluating the Precision of the ACS-NSQIP Risk Calculator for Predicting Negative Postoperative Events in Emergency Situations: A Preliminary Study from an Italian Single Center
7. Current guidance on perioperative cardiac assessment
8. Application of predicting risk of cardiovascular disease events equations on postoperative major adverse cardiac and cerebral events for patients undergoing thoracic surgery
9. Assessment and Optimization of Cardiovascular Risk and Frailty Before Non-Cardiac Surgery: A Comparative Analysis of Recent European and American guidelines. - ScienceDirect
10. Frontiers | The Revised Cardiac Risk Index and 90-Day Mortality After Non-Cardiac Surgery: A Retrospective Cohort Study
11. Association of the Revised Cardiac Risk Index with 1-year postoperative mortality: A single-center retrospective study - ScienceDirect
12. Association of extent of perioperative myocardial infarction/injury with death after noncardiac surgery | European Heart Journal | Oxford Academic
13. Prognostic implications of the high sensitivity C-reactive protein to albumin ratio for major cardiovascular adverse events in patients undergoing noncardiac surgery | Scientific Reports
14. Machine learning vs. traditional methods for predicting postoperative cardiac complications after non-cardiac surgery: a systematic review and Bayesian network meta-analysis - PubMed