MAGENT

Revised Cardiac Risk Index (RCRI): how the six factors add up

The Revised Cardiac Risk Index (RCRI) gives 1 point for each of six factors: high-risk surgery, ischemic heart disease, congestive heart failure, cerebrovascular disease, diabetes on insulin, and creatinine above 2.0 mg/dL. The total runs from 0 to 6. The calculator also returns a class label I–IV; this page doesn't describe it.

Not a medical device. Not a diagnosis or dosing recommendation.

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What is the Revised Cardiac Risk Index?

The RCRI, also called the Lee index, comes from Thomas H. Lee and colleagues, who published it in Circulation in 1999. Their abstract describes a prospective cohort of patients having elective major noncardiac procedures at a teaching hospital. Six factors were found to predict cardiac complications independently, and those six make up the index.

This page explains the counting. The calculator also returns a class label I–IV; this page doesn't describe it, and it doesn't say what a score means for a particular person.

The RCRI formula

RCRI = high-risk surgery          (1 if yes)
     + ischemic heart disease     (1 if yes)
     + congestive heart failure   (1 if yes)
     + cerebrovascular disease    (1 if yes)
     + diabetes on insulin        (1 if yes)
     + creatinine above 2.0 mg/dL (1 if yes)
maximum = 6

Exact expression the calculator uses:

RCRI = high_risk_surgery + ischemic_heart_disease + congestive_heart_failure + cerebrovascular_disease + insulin_diabetes + creatinine_gt_2; each 1; max 6

What each factor means

InputCounts as yes when
high_risk_surgeryIntraperitoneal, intrathoracic or suprainguinal vascular surgery
ischemic_heart_diseaseHistory of myocardial infarction, a positive exercise test, current chest pain from ischemia, nitrate use, or Q waves
congestive_heart_failureHistory of heart failure, pulmonary edema, PND, rales, an S3, or a chest radiograph with vascular redistribution
cerebrovascular_diseaseHistory of stroke or TIA
insulin_diabetesDiabetes managed with insulin before surgery
creatinine_gt_2Serum creatinine above 2.0 mg/dL before surgery

How the score works

  1. Answer the six questions true or false.
  2. Count the trues. Each one is 1 point, so the total is 0 to 6.

Yes/no inputs

Every input is true or false, and anything else is rejected with an error. Age isn't one of the factors. The calculator doesn't convert creatinine units: creatinine_gt_2 is a yes/no flag for the published 2.0 mg/dL cutoff, so a result in another unit has to be compared by the person using it. The calculator returns the total, the maximum of 6, the class label and a line for each factor.

Worked examples

These use Magent's own expected values for the calculator. Each line adds the factors in the order of the table above.

Example 1: no factors

  1. Score: 0 + 0 + 0 + 0 + 0 + 0 = 0.

Example 2: high-risk surgery alone

  1. Score: 1 + 0 + 0 + 0 + 0 + 0 = 1.

Example 3: high-risk surgery and ischemic heart disease

  1. Score: 1 + 1 + 0 + 0 + 0 + 0 = 2.

Example 4: high-risk surgery, ischemic heart disease and heart failure

  1. Score: 1 + 1 + 1 + 0 + 0 + 0 = 3.

History of the RCRI

The calculator cites Lee TH, Marcantonio ER, Mangione CM and colleagues, Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery, Circulation, 1999 (volume 100, issue 10, pages 1043–1049). The abstract describes a derivation cohort and a separate cohort used to test the index.

When it's used

The 1999 study looked at stable patients before nonurgent major noncardiac surgery. Every factor is something known before the operation.

Where it's used

The 1999 study was set in a tertiary-care teaching hospital, in patients having elective major noncardiac procedures. The inputs come from the history, the planned operation and a creatinine result.

Who uses it

The person using the calculator answers the six questions from the history, the planned operation and a creatinine result. The calculator counts them.

Limits of the calculation

  • It counts six yes/no factors. It isn't an operative clearance, a cancellation or a monitoring order.
  • Age isn't part of the index.
  • Creatinine is a yes/no flag at 2.0 mg/dL; no unit conversion is done.
  • The calculator returns a class label I–IV, which this page doesn't describe, and no complication rate.
  • This page doesn't say what to do with a score or class.

Clinical decisions belong to a qualified clinician who knows the patient.

  • HEART score is a separate score for chest pain in the emergency room, with five parts worth up to 2 points each.

Glossary

  • Noncardiac surgery: an operation on any part of the body other than the heart.
  • Suprainguinal vascular surgery: surgery on blood vessels above the groin.
  • TIA: transient ischemic attack, a brief stroke-like episode.
  • PND: paroxysmal nocturnal dyspnea, waking at night short of breath.
  • S3: an extra heart sound heard with a stethoscope.
  • Creatinine: a blood test that reflects kidney function.

Common mistakes

  • Adding a point for age. Age isn't a factor in this index.
  • Entering creatinine as a number. The input is true or false for above 2.0 mg/dL.
  • Counting diabetes without insulin. The factor is diabetes managed with insulin.
  • Counting any operation as high-risk. The factor covers intraperitoneal, intrathoracic or suprainguinal vascular surgery.

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. DOI: 10.1161/01.CIR.100.10.1043. PMID: 10477528

Frequently asked questions

How do you calculate the RCRI?

Answer six yes/no questions and count the yeses. Each is 1 point, so the total is 0 to 6.

Does age count in the RCRI?

No. None of the six factors is age.