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RCRI scoring

RCRI (Revised Cardiac Risk Index)

Adult noncardiac surgery cardiac risk stratification (Lee 1999). Integrate with procedure-specific risk, functional capacity, and guideline-directed evaluation. Last updated: 2026-02-03

Medical Wizardry • Calculators

Clinician-grade • Responsive

Predictors (1 point each)

High-risk surgery Intraperitoneal, intrathoracic, or suprainguinal vascular procedure.

History of ischemic heart disease Per Lee criteria: prior myocardial infarction, positive stress test, current angina, nitrate therapy, or pathological Q waves (operational definitions vary by institution).

History of congestive heart failure Per Lee criteria: heart failure or pulmonary edema; paroxysmal nocturnal dyspnea; S3 gallop; or bilateral rales (documentation preferred).

History of cerebrovascular disease Stroke or transient ischemic attack.

Diabetes requiring insulin therapy

Preoperative creatinine greater than 2.0 milligrams per deciliter Optional entry below can auto-check this factor (unit conversion shown).

Creatinine

Unit

Conversion used: milligrams per deciliter = micromoles per liter ÷ 88.4.

Interpretation caveat: Multiple external validations demonstrate variable discrimination and calibration; RCRI may underestimate events in selected cohorts (notably vascular surgery and some high-risk populations). Prefer a stepwise guideline approach and consider procedure-specific or contemporary models when indicated.

Results

RCRI score

Risk class

Major cardiac complication rates reported in Lee et al. (1999)

Derivation cohort

0.5%

0 predictors

Validation cohort

0.4%

0 predictors

Clinical integration anchor

Contemporary perioperative guidance endorses a stepwise evaluation and use of validated risk-prediction tools (including RCRI) to inform shared decisions and testing thresholds in patients with known cardiovascular disease, risk factors, or symptoms concerning for cardiovascular disease.

Disclaimer: Decision support only. Not a substitute for clinician judgement, institutional pathways, or guideline-directed evaluation.

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