Among 51 ATTR-CM patients undergoing non-cardiac surgery drawn from a 145-patient real-world cohort, a Revised Cardiac Risk Index (RCRI) score of ≥3 was associated with dramatically elevated odds of unplanned postoperative hospital admission (adjusted OR 48.9, 95% CI 4.8–502.2) and prolonged length of stay exceeding 48 hours (adjusted OR 40.7, 95% CI 4.3–382.8). Notably, frailty — present in 61% of this predominantly male cohort averaging 76 years — was not independently predictive after multivariable adjustment.
ATTR-CM has historically been underdiagnosed, but the advent of disease-stabilizing therapies like tafamidis has meaningfully extended patient survival, creating a growing population navigating surgical decisions with an infiltrative cardiomyopathy. The finding that a decades-old general cardiac risk tool retains strong discriminatory power in this specialized population is clinically actionable — surgeons and cardiologists already fluent in RCRI need not await disease-specific instruments before stratifying perioperative risk. However, the extremely wide confidence intervals — spanning nearly two orders of magnitude — betray the study's primary limitation: only 51 patients underwent eligible procedures, making effect size estimates highly unstable. The unexpected non-significance of frailty warrants cautious interpretation rather than de-emphasis of frailty assessment in practice. As a preprint not yet peer-reviewed, these findings could shift after formal scrutiny. Confirmatory studies with larger ATTR-CM surgical cohorts are essential before embedding RCRI thresholds into clinical pathways for this population.
