What is the RCRI score?
Tick the factors that apply to see the Revised Cardiac Risk Index (RCRI), its risk class, and the rate of heart complications the original study found. For information only. This is not medical advice or a diagnosis. Do not use it to make treatment decisions without a clinician. No licensed clinician has reviewed this page.
- RCRI score
- 0
The RCRI score is 0 (Class I); the original study found major cardiac complications in 0.4% of such patients.
- Risk class
- Class I
- Complication rate in the study
- 0.4%
RCRI score: 0. The RCRI score is 0 (Class I); the original study found major cardiac complications in 0.4% of such patients.
Factors out of 6
This calculator gives general information only. It is not medical advice and does not replace a doctor or other health care provider. Talk with a professional about your results. Terms of use
How to calculate
Counts the six factors of the Revised Cardiac Risk Index (Lee 1999) and shows the risk class and the rate of major cardiac complications that the original study found after noncardiac surgery.
Example with the default inputs (High-risk surgery No, Ischemic heart disease No, Heart failure No, Stroke or TIA No, Diabetes treated with insulin No, Creatinine over 2 mg/dL No): The RCRI score is 0 (Class I); the original study found major cardiac complications in 0.4% of such patients.
Method: RCRI = the number of the six Lee factors that apply; class I (0), II (1), III (2), IV (3 or more).
- For adults having elective noncardiac surgery, as in the Lee 1999 study.
- Each factor counts 1 point. The rate is the one Lee and others found in their validation cohort for the class, not a personal prediction.
Worked examples
Each example is checked against the calculator on every build.
- High-risk surgery yes, Ischemic heart disease no, Heart failure no, Stroke or TIA no, Diabetes treated with insulin no, Creatinine over 2 mg/dL no gives RCRI score 1, Risk class Class II, Complication rate in the study 0.9%.Source: Lee et al., Circulation 1999: 1 factor is class II, 0.9% major cardiac complications in the validation cohort
- High-risk surgery no, Ischemic heart disease no, Heart failure no, Stroke or TIA no, Diabetes treated with insulin no, Creatinine over 2 mg/dL no gives RCRI score 0, Risk class Class I, Complication rate in the study 0.4%.Source: Lee et al. 1999: 0 factors is class I, 0.4% in the validation cohort
- High-risk surgery yes, Ischemic heart disease yes, Heart failure no, Stroke or TIA no, Diabetes treated with insulin no, Creatinine over 2 mg/dL no gives RCRI score 2, Risk class Class III, Complication rate in the study 6.6%.Source: Lee et al. 1999: 2 factors is class III, 6.6% in the validation cohort
- High-risk surgery yes, Ischemic heart disease yes, Heart failure yes, Stroke or TIA yes, Diabetes treated with insulin yes, Creatinine over 2 mg/dL yes gives RCRI score 6, Risk class Class IV, Complication rate in the study 11%.Source: Lee et al. 1999: 3 or more factors is class IV, 11% in the validation cohort
Medical disclaimer
This calculator is for information and education only. It is not medical advice, and its result is not a diagnosis. Do not use it to start, stop, or change a treatment without a clinician who knows your health history. No licensed clinician has reviewed this page. This site's editors checked the formulas and worked examples against published sources. If you think you have a medical emergency, call your local emergency number.
When this does not apply. The index is for adults 50 and older having planned (not emergency) major noncardiac surgery (Lee 1999). It does not apply to heart surgery, emergency surgery, or children.
How the score is worked out
Each factor that applies scores 1 point (Lee 1999):
- High-risk surgery: intraperitoneal, intrathoracic, or suprainguinal vascular
- Ischemic heart disease: past heart attack, positive exercise test, current angina, nitrate use, or pathological Q waves on the ECG
- Heart failure: history of heart failure, pulmonary edema, paroxysmal nocturnal dyspnea, rales, an S3 heart sound, or fluid in the lungs on an X-ray
- Cerebrovascular disease: past stroke or TIA
- Diabetes treated with insulin before surgery
- Preoperative serum creatinine over 2.0 mg/dL (177 µmol/L)
The RCRI score is the number of factors, 0 to 6.
Class and rate
| Factors | Class | Major cardiac complications, Lee 1999 validation cohort |
|---|---|---|
| 0 | I | 0.4% |
| 1 | II | 0.9% |
| 2 | III | 6.6% |
| 3 or more | IV | 11% |
The rate is what the study observed in its validation group of 1,422 patients. It is shown with one decimal place.
Worked examples by hand
High-risk surgery only. 1 factor: class II, 0.9%.
No factors. 0: class I, 0.4%.
High-risk surgery and ischemic heart disease. 2 factors: class III, 6.6%.
All six factors. 6 factors, which is 3 or more: class IV, 11%.
Other questions people ask
What is the RCRI?
The Revised Cardiac Risk Index (RCRI), also called the Lee index, estimates the risk of a major heart complication after noncardiac surgery. Lee and others published it in 1999 from 4,315 patients aged 50 or older having elective major surgery. It counts six factors, one point each.
What counts as a major cardiac complication?
In the Lee study: a heart attack, fluid in the lungs from the heart (pulmonary edema), ventricular fibrillation or cardiac arrest, or complete heart block, during the hospital stay after surgery.
What do the classes mean?
Class I is 0 factors, class II is 1, class III is 2, and class IV is 3 or more. In the study group used to check the index, the complication rates were 0.4%, 0.9%, 6.6%, and 11%. Later studies found different rates in other groups, so the numbers are a guide, not a personal prediction.
What is high-risk surgery in the RCRI?
Surgery inside the abdomen (intraperitoneal), inside the chest (intrathoracic), or on the large blood vessels above the groin (suprainguinal vascular).
How do guidelines use the RCRI?
The 2024 AHA/ACC perioperative guideline lists the RCRI as one of several tools to estimate risk before surgery. It is one part of an assessment that also looks at how well a person can exercise and at the type of surgery.