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Revised Cardiac Risk Index (Lee)

Also called RCRI, Lee index, Lee criteria, cardiac risk noncardiac surgery

Six-factor index of major cardiac complications after elective major non-cardiac surgery in patients aged 50 or over.

RCRI points

0 / 6

Class
I
Major cardiac complications
0.5% (derivation) · 0.4% (validation)

Class I: major cardiac complication rate 0.5% in the derivation cohort and 0.4% in the validation cohort (Boston, 1989–94, age ≥ 50, elective major non-cardiac surgery).

Formula and scoring

1 point each: high-risk surgery, ischaemic heart disease, heart failure, cerebrovascular disease, insulin therapy, creatinine > 2.0 mg/dL. 0 / 1 / 2 / ≥ 3 points = class I / II / III / IV.

Exam and ward pearls

  • Diabetes counts only if on insulin; creatinine cut-off is > 2.0 mg/dL (177 µmol/L).
  • "High-risk surgery" = intraperitoneal, intrathoracic or suprainguinal vascular.

When not to rely on it

  • Derived in stable patients ≥ 50 years having non-urgent surgery at one centre; NSQIP-based tools discriminate better (Gupta 2011 reported C-statistic 0.747 for RCRI vs 0.874 for its own model).

Source

  1. 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):1043-9. doi:10.1161/01.cir.100.10.1043 · PMID 10477528
  2. Forssten MP, Bass GA, Scheufler KM, et al. Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index. Eur J Trauma Emerg Surg. 2022;48(6):4481-8 (open-access statement of the high-risk-surgery definition and the 177 µmol/L creatinine equivalent). doi:10.1007/s00068-021-01841-7 · PMID 34839374
  3. Gupta PK, Gupta H, Sundaram A, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124(4):381-7. doi:10.1161/CIRCULATIONAHA.110.015701 · PMID 21730309

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

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