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Revised Cardiac Risk Index (RCRI)

Cardiac risk before non-cardiac surgery (Lee index).

For healthcare professionalsCardiology scoresv1.0.0

For healthcare professionals / clinical use. Not a self-diagnosis tool.

Your measurements

High-risk surgery (intraperitoneal, intrathoracic or suprainguinal vascular)
Ischaemic heart disease
History of heart failure
Cerebrovascular disease (stroke or TIA)
Diabetes treated with insulin
Preoperative creatinine above 2 mg/dL (177 µmol/L)

Calculated on your device. Nothing is sent to a server.

Your result will appear here

Enter your measurements, then press Calculate.

Methodology

Revised Cardiac Risk Index (Lee 1999)

One point each: high-risk surgery, ischaemic heart disease, heart failure, cerebrovascular disease, insulin therapy, creatinine > 2 mg/dL; class I = 0, II = 1, III = 2, IV ≥ 3

Predicts major cardiac complications after non-cardiac surgery; ESC 2022 lists it among tools for preoperative risk assessment.

Who it is for
Adults planned for non-cardiac surgery.
Version
1.0.0

How this calculator works

Where the formula comes from

  • Lee and colleagues (1999) derived the RCRI in a prospective cohort of 4,315 patients aged 50 or over having elective major non-cardiac surgery at a teaching hospital (derivation 2,893, validation 1,422).[1]

The inputs

  • The six predictors are high-risk surgery, ischaemic heart disease, heart failure, cerebrovascular disease, preoperative insulin treatment and creatinine over 2.0 mg/dL, one point each.[1]
  • Major cardiac complication rates with 0, 1, 2 and 3 or more factors were 0.5%, 1.3%, 4% and 9% in the derivation cohort and 0.4%, 0.9%, 7% and 11% in the validation cohort.[1]

Where accuracy falls (published evidence)

  • A 2010 systematic review found moderate discrimination for mixed non-cardiac surgery but poorer performance for vascular surgery and for predicting death.[2]

What guidelines say

  • The 2022 ESC guideline on non-cardiac surgery lists the RCRI among tools for preoperative cardiovascular risk assessment, within a stepwise clinical evaluation.[3]

Sources

  1. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–1049. doi:10.1161/01.CIR.100.10.1043
  2. Ford MK, Beattie WS, Wijeysundera DN. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med. 2010;152(1):26–35. doi:10.7326/0003-4819-152-1-201001050-00007
  3. Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826–3924. doi:10.1093/eurheartj/ehac270

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Limitations

  • Event rates differ between the original and later validation cohorts; local data may differ.
  • Does not include functional capacity or biomarkers.

References

  1. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–1049. doi:10.1161/01.CIR.100.10.1043
  2. Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826–3924. doi:10.1093/eurheartj/ehac270