Enter your patient's 6 clinical risk factors — high-risk surgery, history of ischemic heart disease, congestive heart failure, cerebrovascular disease, pre-operative insulin use, and serum creatinine >2 mg/dL — and the RCRI Calculator returns a total score, risk class (I–IV), and estimated percentage risk of major perioperative cardiac complications.
RCRI Score
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Risk Class
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Estimated Cardiac Risk
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Risk Category
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The RCRI, also known as the Lee Criteria, is a validated clinical tool developed to estimate the risk of major perioperative cardiac complications in patients undergoing non-cardiac surgery. It was derived from a study of stable patients aged 50 or older undergoing elective major non-cardiac procedures. Each of the 6 risk factors scores 1 point, giving a total range of 0–6.
High-risk surgery refers to suprainguinal vascular procedures, intrathoracic surgeries, or intraabdominal surgeries. These procedure types carry a significantly elevated risk of perioperative cardiac complications compared to more minor or peripheral surgeries.
An RCRI score of 0 corresponds to Class I with approximately 0.4% risk, score of 1 to Class II with ~1% risk, score of 2 to Class III with ~2.4% risk, and a score of 3 or more to Class IV with ~5.4% or higher risk of major cardiac complications including MI, pulmonary edema, ventricular fibrillation, cardiac arrest, or complete heart block.
Simply answer Yes or No to each of the 6 clinical criteria: high-risk surgery, history of ischemic heart disease, congestive heart failure, cerebrovascular disease, pre-operative insulin use, and serum creatinine >2 mg/dL. Each 'Yes' adds 1 point to the total score. The calculator then displays the risk class and estimated percentage of major perioperative cardiac complications.
The RCRI predicts major perioperative cardiac complications including myocardial infarction, pulmonary edema, ventricular fibrillation, primary cardiac arrest, and complete heart block occurring within 30 days of surgery.
The RCRI was developed and validated for stable patients aged 50 years or older undergoing elective major non-cardiac procedures. It is particularly useful for identifying patients who may benefit from further cardiac risk stratification or optimization before surgery.
The RCRI was derived from a single tertiary-care teaching hospital and may not generalize to all clinical settings. It does not account for emergency surgeries, patient age directly, or some newer risk factors like obstructive sleep apnea. It should be used alongside clinical judgment and not as a standalone decision tool.
The RCRI uses a pre-operative serum creatinine threshold of greater than 2 mg/dL (or equivalently greater than 177 μmol/L). A creatinine above this level suggests impaired renal function, which is independently associated with increased perioperative cardiac risk.