Lee's Revised Cardiac Risk Index

      I.        CRITERIA

1.    High Risk Surgery (Cardiac Risk >5%):       1 Point

·         intraperitoneal

·         intrathoracic

·         suprainguinal vascular procedures

2.    Coronary Artery Disease:                            1 Point

·         Myocardial Infarction history

·         Positive Exercise Stress Test

·         Chest Pain secondary to Myocardial Infarction

·         Current use of nitrates to control Angina

·         Pathologic Q waves on EKG

3.    Congestive Heart Failure:                           1 Point

·         Pulmonary edema

·         Paroxysmal nocturnal Dyspnea

·         Bibasilar rales

·         S3 Gallup Rhythm

·         Chest XRay demonstrating pulmonary vascular congestion

4.    Cerebrovascular Disease (TIA or CVA):        1 Point

5.    Diabetes Mellitus on Insulin:                       1 Point

6.    Serum Creatinine >2.0 mg/dl:                     1 Point

    II.        INTERPRETATION

A.    Scoring

1.   Points 0: Class I Very Low (0.4% complications)

2.   Points 1: Class II Low (0.9% complications)

3.   Points 2: Class III Moderate (6.6% complications)

4.   Points 3: Class IV High (>11% complications)

B.    Complications predicted by above scoring

1.   Myocardial Infarction

2.   Pulmonary Embolism

3.   Ventricular Fibrillation

4.   Cardiac Arrest

5.   Complete Heart Block

   III.        REFERENCES

A.     Lee et al, (1999). Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery. Circulation 100:1043-9

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