RCRI — Revised Cardiac Risk Index

Pre-operative cardiac risk for non-cardiac surgery

Risk Factors (1 pt each)

High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular)History of ischemic heart disease (prior MI, positive stress test, nitrates, ECG Q waves, prior PTCA/CABG)History of congestive heart failure (pulmonary edema, PND, bilateral rales, S3 gallop, CXR pulmonary vascular redistribution)History of cerebrovascular disease (prior stroke or TIA)Diabetes requiring insulinPreoperative creatinine > 2.0 mg/dL

Risk Reference

0Very Low Risk — 0.4% estimated major cardiac complication rate

1Low Risk — 0.9% estimated major cardiac complication rate

2Moderate Risk — 6.6% estimated major cardiac complication rate

≥3High Risk — ≥11% estimated major cardiac complication rate

0/6Very Low Risk

0.4% estimated major cardiac complication rate

RCRI identifies patients who may benefit from further cardiac evaluation, optimization, or intensified monitoring perioperatively. Consult the 2024 AHA/ACC perioperative guideline.

2024 perioperative guideline context

• RCRI is one validated index; the guideline also endorses NSQIP-based calculators (ACS NSQIP MICA / Surgical Risk Calculator).
• Pair the score with functional capacity — good capacity (≥4 METs: climb 2 flights / walk uphill) generally favors proceeding without further cardiac testing.
• Consider BNP / NT-proBNP before elevated-risk surgery in patients ≥65, or with known/at-risk CVD, to refine risk.
• Order stress imaging only if the result would change management. Continue guideline-directed cardiac meds (e.g., statins, most beta-blockers if already on them); do not start beta-blockers on the day of surgery.

In clinical review. This calculator follows the published score, but our clinical review hasn’t signed off on this implementation yet. Verify every result against the primary source before acting on it.

For clinical decision support only. Does not replace provider judgment. Verify all scores before acting on results.