What is the Revised Cardiac Risk Index?

The RCRI, also called the Lee Index, is a validated clinical scoring tool published by Lee et al. in 1999. It uses six equally weighted criteria to estimate the probability of major adverse cardiac events (MACE) in adult patients undergoing non-cardiac surgery.

What surgeries does the RCRI apply to?

It applies to non-cardiac surgeries — orthopedic, abdominal, thoracic, vascular, urological, and others. It is not intended for cardiac surgery or very low-risk procedures such as cataract surgery or superficial skin procedures.

What qualifies as high-risk surgery?

High-risk surgery in the RCRI includes suprainguinal vascular operations (e.g., aortic reconstruction), intraperitoneal surgery (e.g., bowel resection), and intrathoracic surgery (e.g., lung resection). These procedures carry elevated hemodynamic stress.

What counts as a history of ischemic heart disease?

Any of the following: prior myocardial infarction, current angina presumed ischemic, use of nitrate therapy, a positive exercise stress test, or ECG findings of pathological Q waves consistent with prior MI.

What is a clinically significant RCRI score?

Scores of 2 or more indicate intermediate to high risk and should prompt consideration of cardiology consultation or additional workup before elective procedures. A score of 3 or more carries an estimated MACE risk of about 5.4% or higher.

Does this tool replace clinical judgment?

No. The RCRI is a decision-support aid. Always integrate the score with the full clinical picture, patient preferences, surgical urgency, comorbid conditions, and local institutional protocols. Final decisions rest with the treating clinician.

Revised Cardiac Risk Index

Name: Revised Cardiac Risk Index
Availability: InStock
Author: Nham Vu

Score 6 clinical predictors to estimate the risk of major adverse cardiac events (MACE) before non-cardiac surgery using the validated Lee Index.

Six Clinical Criteria

Check each criterion present in this patient. One point per criterion.

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

History of Ischemic Heart Disease Prior MI, positive stress test, angina, nitrate use, or Q waves on ECG

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 Currently on insulin therapy (not diet or oral agents alone)

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

Risk Assessment

out of 6

Low Risk

RCRI Category

Estimated MACE probability ~0.4%

0% ~10%+

RCRI Score Reference

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 evaluation is typically required with a score of 0. Standard perioperative monitoring is appropriate.

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

Summary

Score 6 clinical predictors to estimate the risk of major adverse cardiac events (MACE) before non-cardiac surgery using the validated Lee Index.

How it works

Review the six clinical criteria and check each one that applies to the patient.
The calculator adds one point per positive criterion for a total RCRI score of 0–6.
The score maps to an estimated MACE risk: 0 points ≈ 0.4%, 1 point ≈ 1%, 2 points ≈ 2.4%, 3 or more ≈ 5.4%+.
A risk category (Low, Low-Intermediate, Intermediate, or High) is displayed alongside the numeric estimate.
Use the result to decide whether further preoperative cardiac workup or cardiology consultation is warranted.
Reset the form to evaluate a new patient.

Use cases

Preoperative cardiac risk stratification before elective non-cardiac surgery.
Guiding decisions about further workup such as stress testing or echocardiography.
Anesthesiology and surgical team communication of perioperative cardiac risk.
Informing shared decision-making conversations with patients before surgery.
Medical education for anesthesia, surgery, and internal medicine trainees.
Rapid bedside assessment in busy preoperative evaluation clinics.
Documenting risk category in perioperative notes for ACC/AHA compliance.

Frequently Asked Questions

Last updated: 2026-07-24 · Reviewed by Nham Vu