How it's calculated
Six independent predictors are each scored 1 point, for a total of 0-6, estimating the risk of a major cardiac complication (MI, cardiac arrest, or death) within 30 days of noncardiac surgery.
Score interpretation
| Score | Class | Approximate risk |
|---|---|---|
| 0 | I | 0.4% |
| 1 | II | 0.9% |
| 2 | III | 6.6% |
| ≥3 | IV | 11% |
Clinical use
- RCRI is used during preoperative assessment to estimate cardiac risk and inform decisions about further cardiac testing, perioperative monitoring, and shared decision-making about proceeding with elective surgery.
- It has largely replaced older indices (like the original Goldman index) for routine preoperative cardiac risk stratification, given its simplicity and validation across diverse surgical populations.
- A score of 0-1 generally does not warrant further cardiac testing before surgery in an otherwise asymptomatic patient; a score of ≥2 often prompts discussion of further workup or optimisation.
- RCRI does not replace clinical assessment of active cardiac conditions (unstable angina, decompensated heart failure, significant arrhythmias) which independently mandate further evaluation regardless of the calculated score.
Frequently asked questions
What is the RCRI used for?
It estimates the risk of a major cardiac complication (heart attack, cardiac arrest, or death) within 30 days of noncardiac surgery, helping guide preoperative risk discussion and the need for further cardiac testing.
What counts as 'high-risk surgery' in the RCRI?
Intraperitoneal, intrathoracic, or suprainguinal vascular surgery — these procedure types carry inherently higher cardiac stress than more superficial or peripheral procedures.
Does a low RCRI score mean surgery is definitely safe?
A low score (0-1) is reassuring and generally means no further cardiac testing is needed in an asymptomatic patient, but it doesn't override the need to assess for active cardiac conditions (like unstable angina or decompensated heart failure), which need attention regardless of the RCRI score.
Has the RCRI been replaced by newer tools?
It remains widely used and is often combined with newer risk calculators (like the ACS NSQIP surgical risk calculator) for a more procedure-specific estimate, but RCRI's simplicity keeps it in routine clinical use.
References
- Lee TH, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk. Circulation. 1999;100:1043-1049.
- Duceppe E, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment. Can J Cardiol. 2017;33:17-32.
- Fleisher LA, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation. Circulation. 2014;130:e278-e333.