Revised Cardiac Risk Index (RCRI) calculator
Tick the risk factors that apply to get the Revised Cardiac Risk Index (Lee index) for a planned non-cardiac operation, with its class from I to IV. It estimates the chance of a major heart complication; it is information, not a decision about surgery.
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How to use it
- Tick high-risk surgery if the planned operation is intraperitoneal, intrathoracic or suprainguinal vascular.
- Tick each condition the patient has: ischemic heart disease, heart failure, stroke or TIA, diabetes on insulin, creatinine above 2 mg/dL (177 µmol/L).
- Read the points and the class.
How the index works
Each of the six factors adds one point.
| Points |
Class |
Major cardiac complications in Lee’s validation group |
| 0 |
I |
about 0.4% |
| 1 |
II |
about 0.9% |
| 2 |
III |
about 6.6% |
| 3 or more |
IV |
about 11% |
Worked example
A 68-year-old with insulin-treated diabetes and a past heart attack is listed for a bowel resection. High-risk surgery 1 + ischemic heart disease 1 + insulin 1 = 3 points, class IV. The same person having a knee replacement would score 2, class III.
Tips
- Ischemic heart disease includes a past heart attack, angina, a positive exercise test, use of nitrates or Q waves on the ECG.
- Creatinine above 2 mg/dL is the same as above 177 µmol/L.
- The RCRI is one part of a pre-operative assessment, along with functional capacity and the type of surgery.
- The result is information only; decisions about surgery belong to the medical team.
Frequently asked questions
What does the RCRI predict?
In Lee's 1999 study it predicted major cardiac complications after elective non-cardiac surgery: heart attack, pulmonary edema, ventricular fibrillation or cardiac arrest, and complete heart block.
What risk goes with each class?
In the original validation group the rates of major cardiac complications were about 0.4% for class I, 0.9% for class II, 6.6% for class III and 11% for class IV. Later studies found different numbers, so treat them as rough guides.
What counts as high-risk surgery?
Operations inside the abdomen (intraperitoneal), inside the chest (intrathoracic) or on blood vessels above the groin (suprainguinal vascular), such as aortic surgery.
Is the RCRI used for heart surgery?
No. It is for non-cardiac operations. Cardiac surgery has its own scores, such as EuroSCORE.