title: Revised Cardiac Risk Index (RCRI) is a useful tool for evaluation of perioperative cardiac morbidity in kidney transplant recipients.
abstract: BACKGROUND
  We evaluated a published Revised Cardiac Risk Index (RCRI) to determine if this preoperative cardiovascular risk stratification tool would be useful in the kidney transplant recipient population.
  
  
  METHODS
  We identified all kidney transplants from 2005 to 2009 (n=1652) at our institution. We performed a detailed retrospective chart review of (a) all recipients who underwent preoperative coronary angiography (n=169) and (b) an age-matched and transplantation year-matched group who did not undergo coronary angiography (n=156). Charts were reviewed for the presence of specific preoperative cardiovascular risk factors and perioperative cardiovascular complications (as defined by RCRI plus elevation of troponin) from time of surgery to hospital discharge. The total number of risk factors for each patient was compared with the occurrence of postoperative cardiac complications to identify a possible association.
  
  
  RESULTS
  The number of risk factors was highly predictive of cardiovascular complications (receiver operating characteristic area, 0.77; P<0.0001). History of coronary artery disease was most strongly associated (odds ratio, 20.59; confidence interval, 4.73-89.53; P=0.0001) and history of congestive heart failure was also significantly associated with cardiac complications (odds ratio, 2.95; confidence interval, 1.01-8.59; P=0.0475).
  
  
  CONCLUSIONS
  The RCRI is a useful tool for cardiac risk stratification in kidney transplantation and could be used to develop protocols for intraoperative and postoperative care to minimize complications.
authors.affiliation: 1 Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA. 2 Transplant Nephrology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA. 3 Cardiology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA. 4 Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA. 5 Address correspondence to: Hans Albin Gritsch, M.D., 10945 Le Conte Avenue, PVUB 3361, Los Angeles, CA 90095-7309.
authors.forename: Nir
authors.initials: N
authors.lastname: Hoftman
authors.forename: Adrian
authors.initials: A
authors.lastname: Prunean
authors.forename: Anahat
authors.initials: A
authors.lastname: Dhillon
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Danovitch
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Hans Albin
authors.initials: HA
authors.lastname: Gritsch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003661:Decision Support Techniques; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin