# Revised 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.

*Source: https://getpathways.ai/glossary/revised-cardiac-risk-index*

Also known as: RCRI, Lee index, cardiac risk index

- **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](/glossary/functional-capacity-mets) 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.