Revised Cardiac Risk Index (RCRI)
Select all risk factors present for your patient. Each is worth 1 point.
High-risk surgery
+1Intraperitoneal, intrathoracic, or suprainguinal vascular surgery
History of ischemic heart disease
+1Prior MI, positive stress test, current chest pain, nitrate therapy, or ECG with Q waves
History of congestive heart failure
+1Pulmonary edema, paroxysmal nocturnal dyspnea, rales, S3, or CXR with pulmonary vascular redistribution
History of cerebrovascular disease
+1Stroke or transient ischemic attack (TIA)
Preoperative treatment with insulin
+1Any insulin use for diabetes preoperatively
Preoperative serum creatinine >2.0 mg/dL (177 μmol/L)
+1Most recent preoperative creatinine >2.0 mg/dL (177 μmol/L)
Clinical Notes:
- • 0 points: 0.4% risk of major cardiac complications
- • 1 point: 0.9% risk
- • 2 points: 6.6% risk
- • ≥3 points: 11.0% risk
- • Use to guide perioperative cardiac risk assessment and management
Revised Cardiac Risk Index (RCRI)
The RCRI is a validated tool to estimate the risk of major cardiac complications (MI, pulmonary edema, ventricular fibrillation, complete heart block, or cardiac arrest) after non-cardiac surgery.
Scoring Criteria
| Risk Factor | Points |
|---|---|
| High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular) | +1 |
| History of ischemic heart disease | +1 |
| History of congestive heart failure | +1 |
| History of cerebrovascular disease (stroke or TIA) | +1 |
| Preoperative treatment with insulin | +1 |
| Preoperative serum creatinine >2.0 mg/dL (177 μmol/L) | +1 |
Risk Stratification
| Score | Risk of Major Cardiac Complications |
|---|---|
| 0 | 0.4% |
| 1 | 0.9% |
| 2 | 6.6% |
| ≥3 | 11.0% |
Clinical Application
- Use to guide perioperative cardiac risk assessment and management.
- Consider further evaluation or intervention for patients with higher scores.
- Does not replace clinical judgment or individualized patient assessment.
Widely used in preoperative evaluation to help inform shared decision-making and perioperative planning.
References
- 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.
- Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. J Am Coll Cardiol. 2014;64(22):e77-e137.
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