Perioperative MACE Risk by Score
| Score | Risk | MACE Rate | Action |
|---|
| 0 | Very Low | ~0.4% | Proceed with surgery |
| 1 | Low | ~0.9% | Proceed; consider stress testing if functional capacity poor |
| 2 | Moderate | ~6.6% | Cardiology consultation; optimize medical therapy |
| ≥3 | High | ~11%+ | Cardiology evaluation; consider further testing or risk-reduction strategies |
RCRI = Sum of 6 binary risk factors (0–6)
MACE = Major Adverse Cardiac Events (MI, pulmonary edema, VF/cardiac arrest, heart block)
Clinical Notes:
• Continue beta-blockers perioperatively if already prescribed; do NOT start new BB day of surgery
• RCRI ≥2: cardioselective beta-blocker may be beneficial if started ≥1 week before surgery
• Low functional capacity (<4 METs) + high RCRI: consider pharmacologic stress testing
• ACC/AHA guideline: RCRI <1 and good functional capacity → proceed without further testing
