Cardiac Risk Calculator for Non-Cardiac Surgery (Revised Cardiac Risk Index – RCRI)
This calculator estimates the risk of major cardiac events (myocardial infarction, cardiac arrest, or death) within 30 days of non-cardiac surgery, based on the Revised Cardiac Risk Index (RCRI), also known as the Lee Index. It is a widely used tool for preoperative cardiac risk stratification.
Please select all applicable risk factors below:
Estimated Cardiac Event Rate:
Understanding the Revised Cardiac Risk Index (RCRI)
The RCRI, developed by Lee et al., assigns one point for each of the six independent predictors of major cardiac complications. The total score then correlates with an estimated risk percentage for events such as myocardial infarction, cardiac arrest, or death within 30 days of non-cardiac surgery.
The Six RCRI Risk Factors Explained:
- High-Risk Surgical Procedure: Certain surgeries carry an inherently higher cardiac risk due to their invasiveness, duration, or physiological stress. Examples include major vascular surgeries (e.g., aortic aneurysm repair), intraperitoneal (e.g., major abdominal surgery), and intrathoracic procedures (e.g., lung resection).
- History of Ischemic Heart Disease (IHD): This includes a past myocardial infarction (heart attack), current angina (chest pain due to reduced blood flow to the heart), a positive stress test indicating ischemia, Q waves on an electrocardiogram (ECG) suggesting previous MI, or current use of nitrates for heart conditions.
- History of Congestive Heart Failure (CHF): Evidence of the heart's inability to pump blood effectively, such as pulmonary edema (fluid in the lungs), an S3 gallop (an abnormal heart sound), or jugular venous distension (swelling of neck veins due to increased pressure).
- History of Cerebrovascular Disease (CVD): A prior stroke (cerebrovascular accident) or transient ischemic attack (TIA), which indicates underlying atherosclerotic disease that can also affect coronary arteries.
- Preoperative Insulin-Dependent Diabetes Mellitus: Diabetes requiring insulin treatment is a significant risk factor for cardiovascular disease and complications.
- Preoperative Renal Insufficiency: Impaired kidney function, typically defined as a serum creatinine level greater than 2.0 mg/dL (or 177 µmol/L), is associated with increased cardiac risk.
Interpreting Your RCRI Score:
The total number of points from the selected risk factors corresponds to the following estimated 30-day cardiac event rates:
- 0 Points: Approximately 0.4% risk
- 1 Point: Approximately 0.9% risk
- 2 Points: Approximately 6.6% risk
- ≥3 Points: Approximately 11% risk
Important Disclaimer:
This calculator is for informational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. The RCRI is a screening tool and does not account for all individual patient factors or the nuances of specific surgical procedures. Always consult with a qualified healthcare professional to discuss your personal medical condition and surgical risks.
Example Calculation:
Let's say a patient is undergoing a major abdominal surgery (High-Risk Surgical Procedure), has a history of angina (History of Ischemic Heart Disease), and takes insulin for diabetes (Preoperative Insulin-Dependent Diabetes Mellitus).
- High-Risk Surgical Procedure: 1 point
- History of Ischemic Heart Disease: 1 point
- History of Congestive Heart Failure: 0 points
- History of Cerebrovascular Disease: 0 points
- Preoperative Insulin-Dependent Diabetes Mellitus: 1 point
- Preoperative Renal Insufficiency: 0 points
Total RCRI Score = 1 + 1 + 1 = 3 points.
According to the RCRI, a score of 3 points or more indicates an estimated cardiac event rate of approximately 11%.