{
  "id": "rcri",
  "version": "26ddbc58f99b",
  "status": "published",
  "name": "RCRI Calculator",
  "question": "What is the RCRI score?",
  "summary": "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.",
  "category": "health",
  "subcategory": "clinical",
  "url": "https://www.acalculator.org/health/rcri-calculator",
  "markdown": "https://www.acalculator.org/health/rcri-calculator.md",
  "kind": "function",
  "method": "RCRI = the number of the six Lee factors that apply; class I (0), II (1), III (2), IV (3 or more).",
  "assumptions": [
    "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."
  ],
  "inputs": {
    "$schema": "https://json-schema.org/draft/2020-12/schema",
    "type": "object",
    "properties": {
      "surgery": {
        "title": "High-risk surgery",
        "description": "Intraperitoneal, intrathoracic, or suprainguinal vascular surgery.",
        "type": "boolean"
      },
      "ihd": {
        "title": "Ischemic heart disease",
        "description": "A past heart attack, a positive exercise test, current chest pain from the heart, nitrate use, or Q waves on the ECG.",
        "type": "boolean"
      },
      "chf": {
        "title": "Heart failure",
        "description": "A history of heart failure, pulmonary edema, a third heart sound, or signs of fluid in the lungs.",
        "type": "boolean"
      },
      "cvd": {
        "title": "Stroke or TIA",
        "description": "A past stroke or transient ischemic attack (TIA).",
        "type": "boolean"
      },
      "insulin": {
        "title": "Diabetes treated with insulin",
        "description": "Diabetes treated with insulin before the surgery.",
        "type": "boolean"
      },
      "creatinine": {
        "title": "Creatinine over 2 mg/dL",
        "description": "Preoperative serum creatinine over 2.0 mg/dL (177 µmol/L).",
        "type": "boolean"
      }
    }
  },
  "outputs": {
    "score": {
      "label": "RCRI score",
      "description": "How many of the six factors apply, 0 to 6.",
      "format": "integer"
    },
    "riskClass": {
      "label": "Risk class",
      "description": "Lee class I (0), II (1), III (2), or IV (3 or more).",
      "format": "text"
    },
    "rate": {
      "label": "Complication rate in the study",
      "description": "Rate of major cardiac complications (heart attack, pulmonary edema, ventricular fibrillation or cardiac arrest, complete heart block) in the Lee 1999 validation cohort for this class.",
      "format": "percent"
    }
  },
  "defaultAnswer": {
    "inputs": {
      "surgery": false,
      "ihd": false,
      "chf": false,
      "cvd": false,
      "insulin": false,
      "creatinine": false
    },
    "outputs": {
      "score": 0,
      "riskClass": "Class I",
      "rate": 0.4
    },
    "text": "The RCRI score is 0 (Class I); the original study found major cardiac complications in 0.4% of such patients."
  },
  "examples": [
    {
      "given": {
        "surgery": true,
        "ihd": false,
        "chf": false,
        "cvd": false,
        "insulin": false,
        "creatinine": false
      },
      "expect": {
        "score": 1,
        "riskClass": "Class II",
        "rate": 0.9
      },
      "source": "Lee et al., Circulation 1999: 1 factor is class II, 0.9% major cardiac complications in the validation cohort"
    },
    {
      "given": {
        "surgery": false,
        "ihd": false,
        "chf": false,
        "cvd": false,
        "insulin": false,
        "creatinine": false
      },
      "expect": {
        "score": 0,
        "riskClass": "Class I",
        "rate": 0.4
      },
      "source": "Lee et al. 1999: 0 factors is class I, 0.4% in the validation cohort"
    },
    {
      "given": {
        "surgery": true,
        "ihd": true,
        "chf": false,
        "cvd": false,
        "insulin": false,
        "creatinine": false
      },
      "expect": {
        "score": 2,
        "riskClass": "Class III",
        "rate": 6.6
      },
      "source": "Lee et al. 1999: 2 factors is class III, 6.6% in the validation cohort"
    },
    {
      "given": {
        "surgery": true,
        "ihd": true,
        "chf": true,
        "cvd": true,
        "insulin": true,
        "creatinine": true
      },
      "expect": {
        "score": 6,
        "riskClass": "Class IV",
        "rate": 11
      },
      "source": "Lee et al. 1999: 3 or more factors is class IV, 11% in the validation cohort"
    }
  ],
  "sources": [
    "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. https://doi.org/10.1161/01.CIR.100.10.1043",
    "Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery. Circulation. 2024;150(19):e351-e442. https://doi.org/10.1161/CIR.0000000000001285"
  ],
  "related": [],
  "changelog": [
    {
      "date": "2026-09-29",
      "note": "Published after this site's editorial review against the cited sources (no clinician review); the page notice says so."
    }
  ]
}