RCRI, Revised Cardiac Risk Index for noncardiac surgery

About this calculator

The index gathers six factors: high-risk surgery, ischaemic heart disease, heart failure, cerebrovascular disease, insulin treatment for diabetes, and creatinine above 2 mg/dL. Each contributes 1 point. Event rates in Lee's 1999 derivation cohort: 0.4 % at 0 points, 0.9 % at 1, 6.6 % at 2, about 11 % at 3 or more. The Devereaux 2005 meta-analysis in a broader sample gave markedly higher figures: 3.9, 6.0, 10.1 and 15 %. Both sets are shown side by side deliberately, because the gap shows how much the estimate depends on the population. The risk table stops at three points: a patient with 3 and a patient with 6 receive the same figure although they differ clinically. That is a limitation of the original publication, not of the calculation. The index does not describe noncardiac complications and does not answer whether preoperative revascularisation is needed: trials showed that routine revascularisation before elective surgery does not improve outcome. Current ESC and ACC guidance uses the RCRI as a first step, after which intermediate and high risk lead on to functional capacity and biomarkers.

Source

Lee TH, Marcantonio ER, Mangione CM et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999;100(10):1043-1049. Обновленные частоты: Devereaux PJ et al. CMAJ 2005;173(6):627-634.

Formula version: lee-1999-devereaux-2005-v1

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