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Revised Cardiac Risk Index (Lee index) for estimating the risk of major perioperative cardiac complications (MI, pulmonary edema, VF or primary cardiac arrest, complete heart block) in patients undergoing non-cardiac surgery.
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
RCRI predicts major cardiac events within 30 days of non-cardiac surgery: 0 predictors ~0.4%, 1 predictor ~0.9%, 2 predictors ~7%, ≥3 predictors ~11%. It guides perioperative cardiac risk stratification but should be combined with functional capacity assessment and the surgical procedure risk.
Specialty
CardiologyCategory
CardiologyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-15
Formula
Keywords
Normal Range
0–6 points
Estimates the 30-day risk of major cardiac complications (MI, pulmonary edema, ventricular fibrillation or primary cardiac arrest, complete heart block) in patients undergoing non-cardiac surgery.
The Revised Cardiac Risk Index adds one point for each of six predictors: high-risk surgery, ischemic heart disease, congestive heart failure, cerebrovascular disease, insulin-treated diabetes, and preoperative creatinine over 2 mg/dL, for a total of 0-6. Higher totals predict greater risk of major perioperative cardiac events.
Intraperitoneal, intrathoracic, or suprainguinal vascular surgery; Yes adds 1 point.
Prior MI, positive stress test, current angina, nitrate use, or prior CABG/PCI; Yes adds 1 point.
History of heart failure with supporting findings; Yes adds 1 point.
Prior TIA or stroke; Yes adds 1 point.
Diabetes requiring insulin; Yes adds 1 point.
Preoperative creatinine over 2 mg/dL; Yes adds 1 point.
Score 0: ~0.4% risk; 1: ~0.9%; 2: ~7%; ≥3: ~11%. Patients with higher scores warrant closer perioperative cardiac monitoring and optimization of modifiable risk factors.
RCRI remains the most widely validated and guideline-endorsed index for perioperative cardiac risk in non-cardiac surgery, framing the preoperative risk assessment.
A 68-year-old insulin-treated diabetic with known ischemic heart disease is scheduled for open colectomy. Preoperative creatinine is 2.2 mg/dL.
Inputs:
Expected Result: RCRI score 4 — HIGH risk (~11% major cardiac events). Close perioperative cardiac monitoring and optimization of cardiac risk factors are warranted.
It estimates the 30-day risk of major cardiac complications after non-cardiac surgery: myocardial infarction, pulmonary edema, ventricular fibrillation or primary cardiac arrest, and complete heart block. It does not predict non-cardiac complications such as infection or renal failure, and it should be combined with functional capacity and procedure-specific risk. Higher scores warrant closer perioperative cardiac monitoring.
It is intended for non-cardiac surgery, so patients undergoing cardiac surgery should use procedure-specific risk tools. It also does not replace clinical assessment of functional capacity or acute cardiac conditions. Because it was derived from a predominantly male single-center cohort, predicted risk may differ in women and contemporary populations. Modifiable risk factors should still be optimized.
A score of 0 corresponds to roughly 0.4% risk, 1 to about 0.9%, 2 to approximately 7%, and 3 or more to about 11% risk of major cardiac events within 30 days. Higher scores warrant closer perioperative cardiac monitoring and optimization of modifiable risk factors before surgery. These estimates frame risk; they do not by themselves postpone or cancel an operation.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. Preoperative risk assessment must integrate the score with functional capacity, surgical risk, and the patient's clinical status.