RCRI Calculator — Revised Cardiac Risk Index (Lee Index)
Score the six Revised Cardiac Risk Index (RCRI / Lee Index) factors to estimate a patient's risk of major adverse cardiac events around non-cardiac surgery.
High-risk surgery (intrathoracic, intraabdominal, or suprainguinal vascular)
History of ischemic heart disease
History of congestive heart failure
History of cerebrovascular disease (stroke or TIA)
Preoperative insulin therapy for diabetes
Preoperative creatinine > 2.0 mg/dL (177 µmol/L)
Risk category: Very Low — estimated MACE risk 0.4%
- 1
Sum the 6 binary risk factors
0 + 0 + 0 + 0 + 0 + 0 = 0Each factor present scores 1 point; absent scores 0. - 2
RCRI Score
0
How does this calculator work?
The RCRI (Lee Index) sums six binary peri-operative cardiac risk factors (0–6 points). Original Lee 1999 MACE estimates: 0 pts → 0.4%, 1 pt → 0.9%, 2 pts → 6.6%, ≥3 pts → 11%. An RCRI ≥ 2 before major elective surgery may warrant additional cardiac evaluation per ACC/AHA guidelines.
Formula
How this is calculated
The Revised Cardiac Risk Index (RCRI), also called the Lee Index, was derived and validated by Lee et al. in 1999 (NEJM 341:1789–1794) from 4,315 patients undergoing elective non-cardiac surgery. It identifies six independent predictors of in-hospital major adverse cardiac events (MACE — cardiac arrest, myocardial infarction, pulmonary oedema, or complete heart block): (1) high-risk surgery type (intrathoracic, intraabdominal, or suprainguinal vascular); (2) history of ischemic heart disease; (3) history of congestive heart failure; (4) history of cerebrovascular disease (prior stroke or TIA); (5) preoperative insulin therapy for diabetes mellitus; and (6) preoperative serum creatinine above 2.0 mg/dL. One point is added for each factor present.
The estimated MACE risk from the original 1999 derivation cohort is: 0 points → 0.4%; 1 point → 0.9%; 2 points → 6.6%; ≥3 points → 11%. Subsequent external validations generally confirm the risk ordering but report different absolute percentages depending on the study population, surgical era, and case mix. Contemporary event rates are often lower due to improved peri-operative care.
The RCRI is endorsed by ACC/AHA guidelines as a first-line peri-operative risk stratification tool. It is an educational and screening aid only — peri-operative cardiac risk decisions require a qualified physician who can consider urgency, functional status, reversibility of cardiac conditions, and patient goals.
Frequently asked questions
Lee et al. defined high-risk surgery as intrathoracic, intraabdominal, or suprainguinal vascular procedures. Orthopaedic, urological, and peripheral vascular procedures below the inguinal ligament are not classified as high-risk by this criterion. Ambulatory and superficial procedures are also excluded.
The 1999 figures (0.4%, 0.9%, 6.6%, ≥11%) reflect an older patient cohort. Modern studies report similar risk ordering but generally lower absolute event rates due to improved peri-operative beta-blockade, statins, and monitoring. The RCRI is best used as a comparative, discriminative tool rather than an absolute predictor.
ACC/AHA guidelines suggest that patients with an RCRI ≥ 2 may benefit from further evaluation (e.g. pharmacological stress testing or echocardiography) if the result would change management before high-risk elective surgery. Patients with an RCRI of 0–1 undergoing elective surgery generally proceed without additional cardiac workup, depending on functional status.
Also known as
TG we-Calculate Editorial Team. (2026). RCRI Calculator — Revised Cardiac Risk Index (Lee Index) [Online calculator]. TG we-Calculate. https://we-calculate.com/calculator/rcri-calculator
TG we-Calculate Editorial Team. "RCRI Calculator — Revised Cardiac Risk Index (Lee Index)." TG we-Calculate. 2026. https://we-calculate.com/calculator/rcri-calculator.
TG we-Calculate Editorial Team, "RCRI Calculator — Revised Cardiac Risk Index (Lee Index)," TG we-Calculate, 2026. [Online]. Available: https://we-calculate.com/calculator/rcri-calculator
@misc{wecalculate_rcri_calculator, title = {RCRI Calculator — Revised Cardiac Risk Index (Lee Index)}, author = {{TG we-Calculate Editorial Team}}, howpublished = {\url{https://we-calculate.com/calculator/rcri-calculator}}, year = {2026}, note = {TG we-Calculate} }
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