Cardiac Risk Assessment (RCRI)
Estimate perioperative cardiac risk before non-cardiac surgery using the Revised Cardiac Risk Index (RCRI). Stratify major adverse cardiac event (MACE) risk and guide the need for preoperative cardiology evaluation.
Based on: ACC/AHA 2014 · ESC 2022
Input
Overview
The Revised Cardiac Risk Index (RCRI) is the most widely validated tool for estimating perioperative major adverse cardiac event (MACE) risk before non-cardiac surgery. Six binary clinical predictors are combined into a simple score (0–6), stratifying 30-day perioperative MACE risk from very low (~0.4%) to high (≥5.4%). RCRI guides the extent of preoperative cardiac evaluation and the need for cardiology referral.
Evidence Summary
The RCRI was derived by Lee et al. (Circulation, 1999) in 4,315 patients and validated in multiple independent cohorts. A 2010 meta-analysis (Devereaux et al.) confirmed discriminative ability for MACE (AUC ~0.75). The 2014 ACC/AHA guideline and the 2022 ESC perioperative guideline both adopt RCRI as a primary cardiac risk stratification tool. Patients with RCRI ≥3 scheduled for high-risk surgery are recommended for cardiology referral and consideration of non-invasive stress testing.