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RCRI Calculator

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Calculate the Revised Cardiac Risk Index (Lee Index) to estimate perioperative cardiac risk before noncardiac surgery, with published risk-class percentages.

High-Risk Surgery (Intraperitoneal, Intrathoracic, or Suprainguinal Vascular) (1 pt)

History of Ischemic Heart Disease (1 pt)

History of Congestive Heart Failure (1 pt)

History of Cerebrovascular Disease (1 pt)

Insulin-Treated Diabetes Mellitus (1 pt)

Preoperative Creatinine > 2.0 mg/dL (1 pt)

RCRI Score

0/ 6

Risk Class

—

Estimated Major Cardiac Risk—

Not a substitute for clinical judgment. Perioperative risk counseling and decisions about further cardiac workup must be made by a qualified healthcare provider, not from this tool alone.

What is a RCRI?

The RCRI Calculator computes the Revised Cardiac Risk Index (Lee Index), a validated tool that estimates the risk of major cardiac complications following noncardiac surgery. The score sums six binary clinical factors: high-risk surgery, ischemic heart disease history, congestive heart failure history, cerebrovascular disease history, insulin-treated diabetes, and significant renal impairment.

Select yes or no for each factor to see your total score, risk class, and the corresponding published cardiac risk percentage. For a related perioperative or cardiac risk tool, see the Gupta Risk Calculator and Duke Treadmill Score Calculator.

How to use this RCRI calculator

  1. Select Yes or No for High-Risk Surgery (Intraperitoneal, Intrathoracic, or Suprainguinal Vascular).
  2. Select Yes or No for History of Ischemic Heart Disease.
  3. Select Yes or No for History of Congestive Heart Failure.
  4. Select Yes or No for History of Cerebrovascular Disease.
  5. Select Yes or No for Insulin-Treated Diabetes Mellitus.
  6. Select Yes or No for Preoperative Creatinine > 2.0 mg/dL.
  7. Review your RCRI Score, Risk Class, and Estimated Major Cardiac Risk, and discuss the result with your surgical and anesthesia team before proceeding.

Formula & Methodology

The RCRI sums the following points, each worth 1 point if present:

- High-risk surgery: 1 point
- Ischemic heart disease: 1 point
- Congestive heart failure: 1 point
- Cerebrovascular disease: 1 point
- Insulin-treated diabetes: 1 point
- Creatinine > 2.0 mg/dL: 1 point

Risk classes (Lee et al. 1999): Class I (0 points, ~0.4% risk), Class II (1 point, ~1.0% risk), Class III (2 points, ~2.4% risk), Class IV (≥3 points, ~5.4% risk).

Worked example: A patient undergoing intrathoracic surgery (1 point) with a history of ischemic heart disease (1 point) scores 1 + 1 = 2 points total, placing them in Class III with an estimated ~2.4% risk of a major cardiac event, per the original Lee et al. 1999 Circulation validation study.

Frequently Asked Questions

The Revised Cardiac Risk Index, also known as the Lee Index, is a validated clinical tool that estimates the risk of major cardiac complications after noncardiac surgery, based on six clinical factors. It was developed by Lee TH, et al. and published in Circulation in 1999.
The six factors are: high-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular), a history of ischemic heart disease, a history of congestive heart failure, a history of cerebrovascular disease, insulin-treated diabetes mellitus, and a preoperative creatinine above 2.0 mg/dL. Each present factor adds one point, for a maximum score of 6.
A score of 0 is Class I with an estimated major cardiac event risk of about 0.4%, a score of 1 is Class II at about 1.0%, a score of 2 is Class III at about 2.4%, and a score of 3 or more is Class IV at about 5.4%, based on the original Lee et al. 1999 validation cohort.
High-risk surgery in the RCRI specifically refers to intraperitoneal, intrathoracic, or suprainguinal vascular procedures — categories associated with greater physiologic stress and higher cardiac complication rates in the original validation study, distinct from other surgery types.
The RCRI was developed and validated specifically for noncardiac surgery in adults; it is not intended for cardiac surgery itself, and its accuracy can vary across different surgical populations and eras compared to the original 1999 cohort.
No — the RCRI estimates population-level risk based on the factors present, but it cannot guarantee an individual outcome. A low score reduces the estimated likelihood of a major cardiac event but does not eliminate it, and unexpected complications can still occur.
Clinicians use the RCRI alongside functional capacity assessment and other clinical judgment to help decide whether additional preoperative cardiac testing, further risk stratification, or perioperative monitoring adjustments are warranted, always as part of a broader evaluation.
Yes — tools such as the Gupta Risk Calculator, using a different set of predictors from the American College of Surgeons NSQIP database, have been developed since the original RCRI and are sometimes used alongside or instead of it depending on institutional preference.
Yes — only diabetes mellitus requiring insulin treatment counts toward the RCRI score; diabetes managed with oral medications or diet alone does not add a point under the original scoring criteria.
A preoperative serum creatinine greater than 2.0 mg/dL is the specific threshold used in the RCRI, reflecting significant renal impairment as an independent risk factor for perioperative cardiac complications in the original validation study.
No — this calculator is strictly for informational and educational purposes and reproduces the published RCRI scoring system only. Any decision about further cardiac testing, perioperative risk management, or surgical clearance must be made by a qualified healthcare provider, never from this tool alone.
It can be, as an educational reference for understanding the terminology a surgical or anesthesia team may use, but the actual risk assessment and any resulting care plan must come from the clinicians directly managing the patient's perioperative care.
Also known as
Lee Index calculatorRevised Cardiac Risk Index calculatorperioperative cardiac risk calculatornoncardiac surgery risk calculatorRCRI score calculator