RCRI - Revised Cardiac Risk Index
The Revised Cardiac Risk Index (RCRI) estimates perioperative cardiac risk in adults undergoing non-cardiac surgery. It is one component of a broader cardiovascular assessment.
The six factors
The factors below are listed with the definitions used in the original 1999 derivation (Lee et al.). Local versions sometimes modify them.
- High-risk procedure: intraperitoneal, intrathoracic or suprainguinal vascular surgery
- History of ischaemic heart disease: for example previous myocardial infarction, positive exercise test, current ischaemic chest pain, nitrate therapy or pathological Q waves on ECG
- History of heart failure: for example previous heart failure, pulmonary oedema, paroxysmal nocturnal dyspnoea, or clinical or radiographic signs of failure
- History of cerebrovascular disease: stroke or transient ischaemic attack
- Diabetes treated with insulin
- Renal dysfunction: preoperative serum creatinine >2.0 mg/dL (177 µmol/L) in the original version
Valid application relies on the original definitions for all six factors. This summary is not an interactive scoring tool.
Limitations
Calibration varies by population and procedure. Historical event percentages may not apply to a particular patient today. RCRI was derived before routine troponin surveillance and in a different surgical era. It does not include functional capacity, frailty, age or anaemia, which may all influence risk.
Practical application
The 2024 AHA/ACC guideline lists RCRI among several available risk scores and notes limitations of risk models. In its stepwise approach, estimated risk is considered together with:
- Urgency of surgery and presence of active cardiac conditions
- Functional capacity
- Biomarkers: the guideline states it is reasonable to measure BNP or NT-proBNP before elevated-risk non-cardiac surgery in patients with known cardiovascular disease, age ≥65, or age ≥45 with symptoms suggestive of cardiovascular disease (class 2a). Troponin measurement may be reasonable in the same group (class 2b).
- Whether additional testing would change management independently of surgery
RCRI is most useful as a structured prompt within that assessment rather than a stand-alone decision tool.
Sources
- Lee et al. Derivation and validation of the Revised Cardiac Risk Index (1999)
- 2024 AHA/ACC guideline for perioperative cardiovascular management for non-cardiac surgery