Loading Calculator...
Please wait a moment
Please wait a moment
Revised Cardiac Risk Index - Estimate perioperative cardiac event risk in noncardiac surgery
Select all that apply (1 point each):
RCRI Score
0
out of 6 risk factors
Risk Classification
Risk of major cardiac event
| RCRI Score | Risk Class | Cardiac Event Risk | Management |
|---|---|---|---|
| 0 | Class I | 0.4% | Proceed without additional testing |
| 1 | Class II | 0.9% | Consider beta-blockers, proceed to surgery |
| 2 | Class III | 6.6% | Medical optimization, consider testing if poor function |
| ≥3 | Class IV | 11% | Cardiology consult, consider stress testing |
Aortic and major vascular surgery, peripheral vascular surgery (suprainguinal). These carry highest cardiac risk.
Major abdominal procedures including bowel resection, hepatobiliary surgery, pancreatic surgery.
Pulmonary resection, esophagectomy, and other major thoracic procedures.
Continue in patients already taking. Consider initiation in high-risk patients days to weeks before surgery.
Continue perioperatively. Consider starting in vascular surgery patients. Reduces cardiac events.
Control hypertension, optimize heart failure, ensure adequate renal function before surgery.
Includes history of MI, current chest pain due to myocardial ischemia, use of nitrate therapy, positive stress test, or pathological Q waves on ECG.
History of CHF, pulmonary edema, paroxysmal nocturnal dyspnea, bilateral rales or S3 gallop on exam, or CXR showing pulmonary vascular redistribution.
Prior transient ischemic attack (TIA) or stroke. Indicates presence of systemic atherosclerosis and increased cardiac risk.
Only diabetes requiring insulin treatment counts. Oral medication alone does not score. Indicates more severe, longer duration diabetes.
Preoperative serum creatinine greater than 2.0 mg/dL (177 μmol/L). Associated with increased perioperative cardiac complications.
Intraperitoneal, intrathoracic, or suprainguinal vascular procedures. These surgeries have inherently higher cardiac stress and risk.
The Revised Cardiac Risk Index (RCRI) is a validated tool developed by Lee et al. in 1999 to estimate the risk of major cardiac complications (MI, pulmonary edema, VF/cardiac arrest, heart block) in patients undergoing noncardiac surgery.
Cardiac testing (stress test, echocardiogram) is generally reserved for patients with ≥3 RCRI risk factors AND poor functional capacity (<4 METs) who are undergoing high-risk surgery. Testing should only be performed if results will change management.
Beta-blockers should be continued in patients already taking them. Starting beta-blockers specifically for surgery is controversial but may be considered in patients with RCRI ≥3, starting days to weeks before surgery with careful dose titration to avoid hypotension.
The RCRI was developed for elective noncardiac surgery. Emergency surgery carries inherently higher risk. While RCRI may provide some guidance, emergency surgery risk assessment must consider additional factors like hemodynamic instability and inability to optimize medical conditions.
RCRI predicts major cardiac events including myocardial infarction, pulmonary edema, ventricular fibrillation or cardiac arrest, and complete heart block. These typically occur within 30 days after surgery.
RCRI remains the most widely used and validated cardiac risk calculator for noncardiac surgery. Other scores like the NSQIP calculator may provide additional information but RCRI offers excellent simplicity and predictive value for clinical decision-making.
The RCRI calculator provides risk estimates based on clinical research and should be used as one component of perioperative risk assessment. Individual patient risk varies based on many factors not captured by this score. All surgical and medical decisions should be made in consultation with qualified healthcare providers.