Revised Cardiac Risk Index (RCRI, Lee)
Score the Revised Cardiac Risk Index (Lee) for predicting major perioperative cardiac events after non-cardiac surgery.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- High-risk surgery
- Yes
- Ischemic heart disease
- Yes
Result: RCRI 2 factors -> ~6.6% major cardiac event risk (Class III per Lee 1999).
The tool opens with these values already filled in. Replace them with your own.
What the result means
- 0
- Class I (very low) — ~0.4% major cardiac event risk per Lee 1999.
- 1
- Class II (low) — ~0.9% major cardiac event risk per Lee 1999.
- 2
- Class III (moderate) — ~6.6% major cardiac event risk per Lee 1999.
- >=3
- Class IV (high) — >=11% major cardiac event risk per Lee 1999.
What you enter
- High-risk surgery (suprainguinal vascular, intraperitoneal, intrathoracic)
- Ischemic heart disease
- History of congestive heart failure
- History of cerebrovascular disease (TIA / CVA)
- Insulin-dependent diabetes mellitus
- Preoperative creatinine > 2.0 mg/dL
What this is
Check the six binary factors that apply to your patient - high-risk surgery type (intraperitoneal, intrathoracic, suprainguinal vascular), ischemic heart disease, congestive heart failure, cerebrovascular disease, insulin-treated diabetes, and a preoperative creatinine >2 mg/dL. Sophie Well totals the points and reports the Lee class with its associated cardiac-event risk band. Source: Lee TH et al. Circulation 1999;100:1043-1049.
When to use it
Use this during the preoperative cardiac assessment for a patient undergoing elective non-cardiac surgery to quantify their baseline 30-day risk of cardiac death, non-fatal MI, or non-fatal cardiac arrest. RCRI is one of the two scores (with NSQIP-MICA) embedded in the 2014 ACC/AHA perioperative algorithm and gates the decision to obtain functional-capacity assessment or non-invasive cardiac testing. It is calibrated for stable elective surgery, not for emergency or trauma operations, and does not replace clinical judgment about an unstable cardiac patient who needs medical optimization before any incision.
How this is calculated
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. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.
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