anaesthesia cardiology
Revised Cardiac Risk Index (RCRI / Lee Index)
Predicts perioperative major adverse cardiac events (MACE) for non-cardiac surgery. Guides preoperative optimisation and monitoring.
Score interpretation
RCRI 0: Very low cardiac risk (<1%)
→ Proceed with surgery; routine monitoring
RCRI 1: Low cardiac risk (~1%)
→ Proceed; consider cardiology review if new symptoms
RCRI 2: Moderate cardiac risk (~2.4%)
→ Cardiology review; echocardiogram if poor functional capacity; preoperative beta-blocker if on chronic therapy
RCRI 3+: High cardiac risk (>5.4%)
→ Cardiology assessment; consider delaying elective surgery for optimisation; discuss risks/benefits
Interpretation bands for the RCRI. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- POSSUM Score for Surgical Morbidity and Mortality · Perioperative Risk
- SORT (Surgical Outcome Risk Tool) · Perioperative Risk
- ASA Physical Status Classification · Perioperative Risk
- Gupta Perioperative Risk for MI or Cardiac Arrest (MICA) · Perioperative Risk
- Cardiovascular Risk in Orthotopic Liver Transplantation (CAR-OLT) Score · Perioperative Risk
- SORT — Surgical Outcome Risk Tool · Perioperative Risk
Drugs
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Rivaroxaban (Perioperative VTE Prophylaxis) · Direct Oral Anticoagulant — VTE Prophylaxis Post-Surgery
- Aprotinin · Antifibrinolytic — Cardiac Surgery
- Protamine Sulphate · Heparin Antidote — Vascular / Cardiac Surgery
- Lidocaine IV (Cardiac Arrhythmia) · Antiarrhythmic
- Mavacamten · Cardiac myosin inhibitor
Pathways
- Sodium channel blocker / LAST · AAGBI Safety Guideline 2010 (LAST); TOXBASE/NPIS; ESC
- Propofol / ketamine toxicity · TOXBASE/NPIS; AAGBI; AACT/EAPCCT
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.