Calculate RCRI (Lee Index) for perioperative cardiac risk stratification. Estimates major adverse cardiac event probability before non-cardiac surgery using 6 clinical predictors.
The Revised Cardiac Risk Index (RCRI), also known as the Lee Index, is the most widely used clinical tool for predicting major adverse cardiac events (MACE) in patients undergoing non-cardiac surgery. Published by Thomas H. Lee and colleagues in 1999, it simplified perioperative risk assessment to just six binary clinical predictors.
Each predictor present adds one point to the score, yielding RCRI classes I through IV with progressively higher MACE rates — from 3.9% with zero risk factors to 15% or more with three or more. MACE in this context includes myocardial infarction, pulmonary edema, ventricular fibrillation or cardiac arrest, and complete heart block.
The RCRI remains one of the core perioperative cardiac-risk worksheets in ACC/AHA-style preoperative evaluation. Its simplicity makes it practical for surgeons, anesthesiologists, internists, and advanced practice clinicians, but it should still be read alongside functional capacity, surgery type, and the rest of the pre-op picture rather than as a stand-alone go/no-go rule.
Perioperative cardiac events remain an important part of non-cardiac surgical risk review. The RCRI is useful because it turns six clinical predictors into one familiar reference point, making it easier to compare cases and decide whether the pre-op discussion needs to go deeper.
RCRI Score = Sum of present risk factors (0–6) Risk factors: (1) High-risk surgery, (2) Ischemic heart disease, (3) CHF, (4) Cerebrovascular disease, (5) Insulin-dependent diabetes, (6) Creatinine > 2.0 mg/dL MACE rates: 0 points = 3.9%, 1 = 6.0%, 2 = 10.1%, ≥3 = 15%+
Result: RCRI Score = 2 (Class III), MACE risk 10.1%
A patient with ischemic heart disease undergoing high-risk abdominal surgery has 2 RCRI points (Class III, 10.1% MACE risk). On this page, that score is a prompt for more detailed perioperative review, especially if functional capacity is limited.
The RCRI works well because it reduces perioperative cardiac risk review to six widely recognized predictors. That makes it easy to document and easy to compare across cases.
The score does not replace functional-capacity review, surgery-specific context, or the broader preoperative cardiovascular assessment. A low score can still sit inside a complicated case, and a higher score does not automatically dictate one next step.
Treat the RCRI as a structured reference point for discussion and documentation. It is most useful when it helps the team decide whether the rest of the pre-op cardiac review can stay simple or needs to go deeper.
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This worksheet applies the six published RCRI predictors to the entered preoperative context and presents the usual score bands as reference context. It is a planning aid for perioperative review, not a clearance decision and not a substitute for clinical judgment or surgery-specific assessment.
Intraperitoneal, intrathoracic, and suprainguinal vascular procedures. This includes major abdominal surgery, thoracic surgery, and aortic or peripheral vascular operations. Orthopedic, head/neck, and most urologic procedures are intermediate risk.
The RCRI has been validated in over 20 independent studies with consistent performance (c-statistic 0.65–0.75). It performs best for discriminating between low and high-risk patients. For precise individual risk prediction, it should be combined with clinical judgment and functional capacity assessment.
Functional capacity (measured in METs) is not part of the RCRI score itself but determines the next step when RCRI ≥ 2. If a patient can climb one flight of stairs or walk two blocks without symptoms (≥ 4 METs), further testing may be unnecessary regardless of RCRI score.
No. RCRI was developed and validated for non-cardiac surgery only. Cardiac surgery risk is assessed with dedicated scores (STS Score, EuroSCORE II) that account for cardiac-specific variables.
Age is not one of the six RCRI predictors but is indirectly captured (older patients are more likely to have the comorbidities that are scored). The ACC/AHA guidelines consider age ≥ 70 an additional risk factor that may lower the threshold for further evaluation.
In the original RCRI study, MACE included myocardial infarction, pulmonary edema, ventricular fibrillation or primary cardiac arrest, and complete heart block. Some later studies also include cardiac death and nonfatal stroke.