RCRI Calculator

Created by Joanna Michałowska, PhD candidate
Reviewed by Bogna Szyk and Jack Bowater
Last updated: Feb 15, 2022

RCRI calculator is a surgical risk tool that will help you assess the possible risk of perioperative cardiac complications for your patient. In this article, you will find out what the Revised Cardiac Risk Index is, why it was created, and what an RCRI score means.

If you want to check a patient's 10-year risk of CVD, try our CVD risk calculator.

Revised Cardiac Risk Index

Identifying a high-risk patient is a critical problem in perioperative medicine, as cardiovascular complications after noncardiac surgeries are a crucial cause of postoperative morbidity and mortality. The first surgical risk index was developed by Goldman et al. in 1977, and has been modified by different researchers since then. This RCRI calculator uses the Revised Cardiac Risk Index developed by Lee et al. in 1999. It contains six different and independent factors that were identified as the strongest predictors of major cardiac complications.

Components of the Revised Cardiac Risk Index

Revised Cardiac Risk Index consist of 6 independent predictors:

  1. History of cerebrovascular disease:

    • transient ischemic attack
    • stroke
  2. History of congestive heart failure that include the presence of any of the following:

    • history of congestive heart failure
    • pulmonary edema
    • paroxysmal nocturnal dyspnea
    • physical examination showing bilateral rales or S3 gallop
    • chest radiograph showing pulmonary vascular redistribution
  3. History of ischemic heart disease that include the presence of any of the following:

    • history of myocardial infarction
    • positive exercise test
    • current complaint of ischemic chest pain
    • use of nitrate therapy
    • ECG with Q waves
  4. Pre-surgery creatinine level >2 mg/dL (176.8 µmol/L)

  5. Pre-surgery treatment with insulin for diabetes

  6. High-risk type surgery:

    • intraperitoneal
    • intrathoracic
    • suprainguinal vascular

How to use RCRI calculator?

The Revised Cardiac Risk Index assigns 1 point to each risk factor. In other words, if a question in this RCRI calculator can be answered "Yes," then 1 point is scored. Patients are then assigned to four different classes depending on their RCRI score:

  • RCRI score 0 = class I
  • RCRI score 1 = class II
  • RCRI score 2 = class III
  • RCRI score 3 or higher = class IV

What RCRI score and class mean?

The following table shows total RCRI score, the class assigned, and the corresponding risk of myocardial infarction, cardiac arrest, or death 30 days after a noncardiac surgery.

RCRI score Class % risk
0 I 3.9
1 II 6.0
2 III 10.1
3 or more IV 15.0

Perioperative guidelines

Below you can find recommendations to help minimise the risk of complications for patients undergoing noncardiac surgery from the The Canadian Cardiovascular Society Guidelines Committee:

  1. Measure brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery in the following patients:

    • aged 65 or older
    • aged 45-64 years of age with significant cardiovascular disease or RCRI score ≥ 1
  2. The following tests should not be performed, as they enhance perioperative cardiac risk:

    • resting echocardiography
    • coronary computed tomography angiography
    • exercise or cardiopulmonary exercise testing
    • pharmacological stress echocardiography
    • radionuclide imaging
  3. Acetylsalicylic acid therapy for the prevention of perioperative cardiac events should not be initiated or continued, except in patients with a recent coronary artery stent or who will undergo a carotid endarterectomy.

  4. α2 agonist or β-blocker therapy should not be initiated at any point 24 hours prior to surgery.

  5. Angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker therapy should not be started in the 24 hours before surgery

  6. No cigarettes should be smoked before surgery

  7. Measurement of daily troponin for 48 to 72 hours after surgery in the following patients:

    • with an elevated NT-proBNP/BNP measurement before surgery
    • if there is no NT-proBNP/BNP measurement before surgery
    • with RCRI score ≥1
    • aged 45-64 with significant cardiovascular disease
    • aged 65 or older
  8. Initiation of long-term acetylsalicylic acid and statin therapy in patients who suffer from myocardial injury or infarction after surgery.

Cardiovascular health

Cardiovascular disease (CVD) is a term that describes conditions affecting the patient's heart and blood vessels. There are four main types of CVD:

  • coronary heart disease

  • strokes and transient ischaemic attacks

  • peripheral arterial disease

  • Aortic disease.

The causes of CVD are listed below. Patients should be aware that some of them are modifiable, and a healthy lifestyle can prevent them from suffering from cardiovascular disease:


  • Cohn SL et al. Comparison of 4 Cardiac Risk Calculators in Predicting Postoperative Cardiac Complications After Noncardiac Operations.

  • Duceppe E. et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

  • Lee TH et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.

  • Cardiovascular Disease, NHS website

Joanna Michałowska, PhD candidate
History of cerebrovascular disease?
History of congestive heart failure?
History of ischemic heart disease?
Pre-surgery creatinine level >2 mg/dL (176.8 µmol/L)?
Pre-surgery treatment with insulin?
High risk noncardiac surgery?
Total RCRI points
30-day risk of death, MI, or cardiac arrest
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