Risk assessment
Revised Cardiac Risk Index
Also known as: RCRI, Lee index, cardiac risk index
The Revised Cardiac Risk Index estimates the risk of major cardiac complications after non-cardiac surgery. It counts six factors — high-risk surgery, ischaemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, and impaired renal function — each scoring one point. More factors means higher risk, and it is used alongside functional capacity rather than instead of it.
- Predicts
- Major cardiac complications after non-cardiac surgery
- Factors
- 6, each scoring one point
- Scoring
- More factors present means higher estimated risk
- Used with
- Functional capacity, not as a replacement for it
The six factors
| Factor | Counts when |
|---|---|
| High-risk surgery | Intraperitoneal, intrathoracic or suprainguinal vascular procedures |
| Ischaemic heart disease | History of myocardial infarction, angina, or related findings |
| Congestive heart failure | History of heart failure |
| Cerebrovascular disease | Prior stroke or transient ischaemic attack |
| Insulin-treated diabetes | Diabetes requiring insulin |
| Renal impairment | Raised serum creatinine above the local threshold |
What it is good for, and what it is not
The RCRI is a screening aid. It turns a set of facts already in the history into a structured estimate, which makes it useful for deciding who warrants closer cardiac assessment and for framing a conversation about risk.
It is not a decision. It says nothing about the patient’s day-to-day exercise tolerance, which is why it is read alongside functional capacity rather than instead of it — a patient with two RCRI factors who comfortably climbs two flights of stairs is not in the same position as one who cannot manage a single flight.
Why it depends on the history being complete
Every factor is drawn from history and existing results. A patient who does not mention a transient ischaemic attack from four years ago, or whose insulin is recorded as “something for sugar”, produces a score that is confidently wrong.
Structured interviewing across every domain is what makes an index like this worth calculating at all. Pathways screens on the underlying findings rather than asking a clinician to reconstruct them from a narrative.