RCRI (Revised Cardiac Risk Index)

Cardiac risk before major non-cardiac surgery — Lee index

High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular)

History of ischaemic heart disease

History of congestive heart failure

History of stroke or TIA

Diabetes treated with insulin

Preoperative creatinine > 2.0 mg/dL (177 µmol/L)

Evidence

Original publication

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. Six independent predictors (high-risk surgery, ischaemic heart disease, congestive heart failure, cerebrovascular disease, insulin-treated diabetes, preoperative creatinine > 2.0 mg/dL); rates of major cardiac complications 0.4%, 0.9%, 6.6%, and ≥ 11% for 0, 1, 2, and ≥ 3 factors.

Circulation, 1999

Open source

Guideline

The RCRI is embedded in the 2014 ACC/AHA and 2022 ESC/ESA perioperative cardiovascular guidelines as a first-line clinical risk index for non-cardiac surgery; contemporary cohorts give somewhat higher absolute event rates than the 1999 derivation.

Last reviewed: 2026-09

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