Revised Cardiac Risk Index

CRNA Study Suite · Lee Index · Preop Cardiac Risk
All Calculators RCRI
Risk Factors (1 pt each)
RCRI Score
0
of 6
30-Day Major Adverse Cardiac Event (MACE) Risk
RCRI ScoreRisk of MACE
00.4%
10.9%
26.6%
≥3≥11%
Lee et al., Circulation 1999. (Referenced in Sheets, 2023, pp. 349-353)
Clinical Use
• Elevated risk (≥2 factors or score ≥ 2): Consider functional capacity (METs) assessment — can patient climb 2 flights of stairs?
• If METs < 4 and surgery is elevated-risk: consider stress testing or cardiology consult per ACC/AHA algorithm
• High-yield: this is one of the most commonly cited preop cardiac risk scores on CRNA boards
(Sheets, 2023, pp. 349-353)
References

Lee, T. H., Marcantonio, E. R., Mangione, C. M., Thomas, E. J., Polanczyk, C. A., Cook, E. F., Sugarbaker, D. J., Donaldson, M. C., Poss, R., Ho, K. K. L., Ludwig, L. E., Pedan, A., & Goldman, L. (1999). Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation, 100(10), 1043-1049.

Sheets, S. A. (2023). Preoperative evaluation and preparation of the patient. In S. Elisha, J. S. Heiner, & J. J. Nagelhout (Eds.), Nurse anesthesia (7th ed., pp. 336-375). Elsevier.

How this works

The RCRI criteria

The Revised Cardiac Risk Index lists clinical risk factors used to estimate perioperative cardiac risk: renal insufficiency (creatinine over 2 mg/dL), ischemic heart disease, high risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular), history of congestive heart failure, insulin dependent diabetes, and history of cerebrovascular disease (Sheets, 2023, p. 354).

Interpreting the score

Risk of a major perioperative cardiac event rises with the number of factors present: 0.4% with zero, 0.9% with one, 6.6% with two, and 11% with three or more (Sheets, 2023, p. 354). Functional capacity below 4 METs compounds this. Patients with multiple factors and poor functional capacity warrant closer stratification, preoperative testing only when it would change management, and vigilant intraoperative hemodynamic control (Sheets, 2023, pp. 354-355).

References

Sheets, S. A. (2023). Preoperative evaluation and preparation of the patient. In Elisha, Heiner, & Nagelhout (Eds.), Nurse anesthesia (7th ed., pp. 336-375). Elsevier.