What does RCRI stand for?

RCRI stands for Revised Cardiac Risk Index. It was developed by Lee et al. in 1999 and is sometimes called the Lee Index. It is one of the most widely validated tools for perioperative cardiac risk assessment.

What types of surgery does the RCRI apply to?

The RCRI is validated for non-cardiac surgery (e.g., orthopedic, abdominal, thoracic, vascular). It does not apply to cardiac surgery itself or very low-risk procedures like cataract surgery.

What counts as high-risk surgery in the RCRI?

High-risk surgery includes suprainguinal vascular procedures, intraperitoneal surgery, and intrathoracic surgery. These are associated with significant hemodynamic stress and higher baseline cardiac event rates.

What is included in the history of ischemic heart disease criterion?

This includes prior myocardial infarction (MI), a positive exercise stress test, current chest pain presumed to be ischemic, use of nitrate therapy, or ECG changes consistent with prior MI (Q waves).

How should I interpret an RCRI score of 3 or more?

A score of 3 or more places the patient in the high-risk category with an estimated MACE risk of approximately 5.4% or greater. ACC/AHA guidelines recommend considering further evaluation or optimization before elective surgery.

Is this calculator a substitute for clinical judgment?

No. The RCRI is a decision-support tool to supplement, not replace, clinical judgment. Always integrate the score with the full clinical picture, patient preferences, surgical urgency, and institutional guidelines.

RCRI Score Calculator

Name: RCRI Score Calculator
Availability: InStock
Author: Nham Vu

Calculate the Revised Cardiac Risk Index (Lee Index) to estimate perioperative cardiac complication risk before non-cardiac surgery.

Clinical Criteria

Check each criterion that applies to the patient.

High-Risk Surgery Suprainguinal vascular, intraperitoneal, or intrathoracic procedure

History of Ischemic Heart Disease Prior MI, positive stress test, angina, nitrate use, or ischemic ECG changes

History of Congestive Heart Failure Pulmonary edema, bilateral rales, S3 gallop, or paroxysmal nocturnal dyspnea

History of Cerebrovascular Disease Prior stroke or transient ischemic attack (TIA)

Insulin-Dependent Diabetes Mellitus Patient is currently on insulin therapy for diabetes

Preoperative Creatinine > 2.0 mg/dL Serum creatinine above 2.0 mg/dL (177 µmol/L) before surgery

Risk Assessment Result

out of 6

Low Risk

RCRI Category

Estimated MACE Risk ~0.4%

0% ~10%+

Score	Category	MACE Risk
0	Low	~0.4%
1	Low	~1.0%
2	Intermediate	~2.4%
3+	High	~5.4%+

Clinical Guidance

Proceed with surgery. No further cardiac workup is typically required for patients with a score of 0. Standard perioperative monitoring is appropriate.

For clinical decision support only. Always integrate with full clinical context, ACC/AHA guidelines, and institutional protocols. Not a substitute for physician judgment.

Summary

Calculate the Revised Cardiac Risk Index (Lee Index) to estimate perioperative cardiac complication risk before non-cardiac surgery.

How it works

Select each of the 6 clinical criteria that apply to the patient.
The calculator sums the number of positive criteria to produce the RCRI score (0–6).
The score maps to an estimated risk of major cardiac events: 0 criteria = ~0.4%, 1 = ~1%, 2 = ~2.4%, 3+ = ~5.4% or higher.
Risk category (Low, Intermediate, High) is displayed along with the numeric probability.
Use the result to guide preoperative cardiac evaluation and management per ACC/AHA guidelines.

Use cases

Preoperative cardiac risk stratification before elective non-cardiac surgery.
Anesthesiology consultation and perioperative planning.
Guiding decisions about further cardiac workup (e.g., stress testing, echocardiography).
Communicating perioperative risk to patients and surgical teams.
Medical education and clinical training for surgery and anesthesia residents.
Rapid bedside decision support in busy preoperative assessment clinics.

Frequently Asked Questions

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Last updated: 2026-05-23 · Reviewed by Nham Vu