Revised Cardiac Risk Index (RCRI)

Predict the risk of major cardiac complications after non-cardiac surgery.

Preoperative Risk Factors

High-risk surgery (e.g., intraperitoneal, vascular)?History of Ischemic Heart Disease?History of Congestive Heart Failure?History of Cerebrovascular Disease (Stroke/TIA)?Preoperative treatment with Insulin?Preoperative Creatinine > 2.0 mg/dL (177 µmol/L)?

Surgical Risk Estimate

RCRI Score0pts

Risk of MACE0.4%Group I

Interpretation:

Low Risk. Estimate of major cardiac complications.

RCRI is a guide. Surgical urgency and other comorbidities (e.g. COPD, functional status) must be considered.

Overview

The Lee Revised Cardiac Risk Index (RCRI) is a widely used tool to estimate the risk of major adverse cardiac events (MACE) in patients undergoing stable non-cardiac surgery. It helps surgical and anesthesia teams decide on preoperative optimization and monitoring.

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Pro Tips

Ischemic heart disease: History of MI, positive stress test, or use of nitrate therapy.
Cerebrovascular disease: History of stroke or TIA.
History of heart failure: Includes patients with prior pulmonary edema or paroxysmal nocturnal dyspnea.

Fun Facts

"Major cardiac complications include MI, pulmonary edema, ventricular fibrillation, and heart block."
"RCRI is designed for patients ≥ 45 years old (or 18-44 with known cardiovascular disease)."
"It applies to surgeries that are not considered 'low-risk' (like ophthalmological procedures)."
"Prospective studies have validated these risk estimates across diverse surgical populations."

Formula: One point is assigned for each of the six risk factors present.

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