Surgical Cardiac Risk Calculator (RCRI)
(e.g., prior MI, angina, positive stress test, Q waves on ECG)
(e.g., prior CHF diagnosis, pulmonary edema)
(e.g., prior stroke, TIA)
(Creatinine > 2.0 mg/dL or 177 µmol/L)
Your Cardiac Risk Assessment:
Please select the relevant factors and click "Calculate Risk" to see the results.
Your Cardiac Risk Assessment:
Revised Cardiac Risk Index (RCRI) Score: ${rcriScore} Estimated Risk of Major Cardiac Event: ${riskPercentage}% Risk Category: ${riskCategory} (Major cardiac event includes cardiac death, nonfatal myocardial infarction, or nonfatal cardiac arrest) `; }Understanding Your Cardiac Risk for Non-Cardiac Surgery
Undergoing surgery, even for non-cardiac conditions, carries a certain level of risk for cardiac complications. Assessing this risk beforehand is crucial for patient safety and for guiding perioperative management. The calculator above utilizes the Revised Cardiac Risk Index (RCRI), also known as the Lee Index, a widely validated tool used by clinicians to estimate the likelihood of major cardiac events following non-cardiac surgery.
What is the Revised Cardiac Risk Index (RCRI)?
Developed by Dr. Lee and colleagues, the RCRI identifies six independent predictors of major cardiac complications (myocardial infarction, cardiac arrest, or death) within 30 days of non-cardiac surgery. Each risk factor present contributes one point to the total score. The higher the score, the greater the estimated risk.
The Six RCRI Risk Factors Explained:
- High-Risk Type of Surgery: Certain surgical procedures inherently carry a higher cardiac risk due to their invasiveness, duration, or potential for significant fluid shifts and blood loss. These typically include intraperitoneal, intrathoracic, and suprainguinal vascular surgeries.
- History of Ischemic Heart Disease (IHD): This includes a prior myocardial infarction (heart attack), current angina, a positive stress test for ischemia, or Q waves on an electrocardiogram (ECG) indicating previous heart damage.
- History of Congestive Heart Failure (CHF): A previous diagnosis of heart failure, characterized by the heart's inability to pump enough blood to meet the body's needs, significantly increases cardiac risk.
- History of Cerebrovascular Disease (CVD): A past stroke or transient ischemic attack (TIA) indicates underlying systemic vascular disease, which can also affect the heart.
- Preoperative Insulin-Dependent Diabetes Mellitus (IDDM): Diabetes, especially when requiring insulin, is a known risk factor for cardiovascular disease and its complications.
- Preoperative Renal Insufficiency: Impaired kidney function, defined as a serum creatinine level greater than 2.0 mg/dL (or 177 µmol/L), is associated with increased cardiac risk.
How the RCRI Score Translates to Risk:
The total RCRI score directly correlates with the estimated risk of major cardiac events:
- 0 Points: Approximately 0.4% risk
- 1 Point: Approximately 0.9% risk
- 2 Points: Approximately 6.6% risk
- ≥3 Points: Approximately 11.0% risk
Example Calculation:
Let's consider a patient undergoing a high-risk vascular surgery. They have a history of a previous heart attack (IHD) and are insulin-dependent for their diabetes. Their creatinine is normal, and they have no history of CHF or CVD.
- High-Risk Surgery: +1 point
- History of IHD: +1 point
- Preoperative IDDM: +1 point
- Total RCRI Score: 3 points
Based on the RCRI, this patient would have an estimated risk of approximately 11.0% for a major cardiac event.
Important Considerations:
While the RCRI is a valuable tool, it is important to remember that it is a screening instrument and not a definitive diagnostic test. It provides an estimate of risk based on a specific set of factors. Individual patient circumstances, other comorbidities, functional capacity, and the specific details of the surgical procedure can all influence the actual risk. This calculator should not replace professional medical advice or clinical judgment. Always discuss your specific health concerns and surgical risks with your healthcare provider.