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Revised Cardiac Risk Index (RCRI) Calculator
The Revised Cardiac Risk Index (RCRI, also called the Lee index) gives one point for each of six factors: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, insulin treatment and creatinine above 2.0 mg/dL. In Lee's 1999 study, major cardiac complication rates with 0, 1, 2 or 3 or more points were 0.4%, 0.9%, 7% and 11% in the validation cohort. Tick the factors below to get the score.
Prepared by Prospyr · Reviewed October 3, 2026 · Free, no sign-up, runs in your browser
Tick each Lee criterion that applies (1 point each)
The six predictors from Lee et al., 1999. Nothing ticked scores 0.
RCRI score
0of 6 points
Lee class I: 0 predictors
Derivation cohort
0.5%
Validation cohort
0.4%
Rate of major cardiac complications reported by Lee et al. in patients aged 50 or older having elective major noncardiac surgery.
| Points | Derivation | Validation |
|---|---|---|
| 0 (yours) | 0.5% | 0.4% |
| 1 | 1.3% | 0.9% |
| 2 | 4% | 7% |
| 3 or more | 9% | 11% |
Decision support only; it does not replace clinical judgment. These are published cohort rates, not a prediction for one patient, and not a recommendation about testing, treatment or surgery.
RCRI score: the six Lee index criteria
One point for each factor that is present. The creatinine threshold is 2.0 mg/dL, which is about 177 µmol/L.
| Criterion | Points |
|---|---|
| High-risk type of surgery | 1 |
| History of ischemic heart disease | 1 |
| History of congestive heart failure | 1 |
| History of cerebrovascular disease | 1 |
| Preoperative treatment with insulin | 1 |
| Preoperative serum creatinine above 2.0 mg/dL | 1 |
| Maximum | 6 |
Revised cardiac risk index: published complication rates by score
These are the rates of major cardiac complications that Lee et al. reported. The derivation cohort was 2,893 patients and the validation cohort 1,422. Both cohorts were patients aged 50 or older having elective major noncardiac procedures.
| RCRI points | Lee class | Derivation cohort | Validation cohort |
|---|---|---|---|
| 0 | I | 0.5% | 0.4% |
| 1 | II | 1.3% | 0.9% |
| 2 | III | 4% | 7% |
| 3 or more | IV | 9% | 11% |
The two cohorts disagree for the 2-point and 3-point groups (4% versus 7%, and 9% versus 11%), which is a reminder of how wide the uncertainty is in small groups. A Cochrane review of biomarkers added to the RCRI opens by noting that the RCRI does not always make accurate predictions.
Worked example
A 62-year-old patient with insulin-treated diabetes and a prior stroke is having a procedure that is not intraperitoneal, intrathoracic or suprainguinal vascular. Creatinine is 1.1 mg/dL. The ticked items are insulin treatment (1) and cerebrovascular disease (1), so the RCRI is 2. The rate Lee reported for 2 points is 4% in the derivation cohort and 7% in the validation cohort. Add heart failure and the score becomes 3, with reported rates of 9% and 11%.
The tool shows the same arithmetic live. Your ticks are saved in the page address, so you can send the result to a colleague.
Using the RCRI in plastic and aesthetic surgery practices
The RCRI was built on major noncardiac surgery in patients 50 and older, so it does not describe most aesthetic procedures well. It can still be a quick way to record the cardiac history in a structured way next to other preoperative scores, such as the ASA physical status classification, the STOP-Bang calculator and the Caprini score calculator.
Guidelines use the RCRI as one input. The 2017 Canadian Cardiovascular Society guideline, for example, uses an RCRI of 1 or more as one of the criteria in some of its recommendations. Read the guideline itself for what it recommends; this tool does not.
If your practice scores patients before surgery, the result belongs in the chart with the history it came from. Prospyr's charting keeps that with the rest of the visit, and the plastic surgery practice software page shows the surgical workflow.
Frequently asked questions
What is the Revised Cardiac Risk Index (RCRI)?
The RCRI is a six-item index published by Lee and colleagues in Circulation in 1999 to estimate the risk of major cardiac complications after major noncardiac surgery. Each item present scores one point, so the total runs from 0 to 6. It is also called the Lee index or Lee score.
What are the six RCRI criteria?
High-risk type of surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine above 2.0 mg/dL. These are the six independent predictors named in the Lee 1999 abstract.
What does an RCRI score of 0, 1, 2 or 3 mean?
Lee reported major cardiac complication rates of 0.5%, 1.3%, 4% and 9% for 0, 1, 2 and 3 or more factors in the derivation cohort, and 0.4%, 0.9%, 7% and 11% in the validation cohort. These are group rates from one study. They are not a prediction for an individual patient.
What counts as high-risk surgery in the RCRI?
The index is usually applied with high-risk surgery meaning intraperitoneal, intrathoracic or suprainguinal vascular procedures. Most office-based and ambulatory aesthetic procedures fall outside those categories, so the surgery item is usually not ticked for them. Whether the index suits a given patient is the clinician's call.
Does the RCRI apply to patients under 50?
The index was derived and validated in 4,315 patients aged 50 or older having elective major noncardiac surgery at a tertiary-care teaching hospital. Using it outside that group goes beyond the population it was built on, so treat the published rates with extra caution.
Is the RCRI the same as the Lee index or the Lee score?
Yes. Lee index, Lee score and RCRI all refer to the same six-item Revised Cardiac Risk Index from the 1999 Circulation paper.
Does this calculator clear a patient for surgery?
No. It adds up six published criteria and shows the rates Lee reported for that score. It does not recommend testing, treatment, medication changes or whether surgery should go ahead. Those decisions belong to the treating team.
Sources and scope
- 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;100:1043-9
The six predictors, the 4,315-patient cohort aged 50 or older, and the 0, 1, 2, 3+ complication rates in the derivation and validation cohorts.
- Duceppe E, Parlow J, MacDonald P, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol 2017;33:17-32
Uses an RCRI of 1 or more as one criterion in several recommendations. Cited only to show how guidelines use the index.
- Cochrane review: The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index (2021)
States that the RCRI does not always make accurate predictions.
Decision support only; it does not replace clinical judgment. The RCRI is a published risk index. This calculator reports the score and the rates in the original paper. It does not recommend testing, treatment, or clearance for surgery.