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RCRI (Revised Cardiac Risk Index)

Estimates perioperative cardiac risk for non-cardiac surgery

When to Use

  • Patients >= 45 years (or >= 18 with known cardiovascular disease) undergoing non-cardiac surgery
  • Elective or semi-urgent surgery requiring general or regional anesthesia
  • Part of the ACC/AHA stepwise perioperative cardiac risk assessment algorithm

When NOT to Use

  • Emergency surgery where the result will not change management
  • Low-risk procedures (endoscopy, cataract surgery, superficial procedures)
  • Patients already scheduled for coronary angiography
Running Total0 / 6
High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular)(+1 point)
History of ischemic heart disease (MI, positive stress test, angina, nitrate use, Q waves)(+1 point)
History of congestive heart failure (pulmonary edema, bilateral rales, S3, CXR with pulmonary vascular redistribution)(+1 point)
History of cerebrovascular disease (stroke or TIA)(+1 point)
Diabetes mellitus requiring insulin therapy(+1 point)
Preoperative serum creatinine > 2 mg/dL (177 umol/L)(+1 point)

Evidence & References

  • Lee TH, Marcantonio ER, 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.PMID: 10477528
  • Duceppe E, Parlow J, 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.PMID: 27865641
Disclaimer: This calculator is a clinical decision aid and does not replace clinical judgment. Always consider the full clinical context when making patient care decisions.