Revised Cardiac Risk Index (RCRI)
Lee's Revised Cardiac Risk Index estimates the risk of major cardiac events (MI, cardiac arrest, complete heart block, pulmonary oedema) in non-cardiac surgery
Score interpretation
Major cardiac complications 0.4% (Lee 1999 validation cohort; 0.5% derivation).
→ Proceed to surgery. No additional cardiac testing required in most cases.
Major cardiac complications 0.9% (Lee 1999 validation cohort; 1.3% derivation).
→ Proceed to surgery. Consider optimising modifiable risk factors.
Major cardiac complications 7% (Lee 1999 validation cohort; 4% derivation).
→ Consider further evaluation (e.g. BNP/NT-proBNP per CCS 2017) only if it will change management; cardiology input.
Major cardiac complications 11% (Lee 1999 validation cohort; 9% derivation).
→ Cardiology review before surgery. Weigh risks vs benefits. Consider postoperative troponin surveillance and HDU monitoring.
Interpretation bands for the RCRI. Apply clinical judgement and local guidance.
References
- Lee TH, 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.
- Duceppe E, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol. 2017;33(1):17–32.
Related
Curated clinical cross-links plus same-class fallbacks.
- 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
- 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
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.