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Revised Cardiac Risk Index (Lee)

Estimates major cardiac-complication risk (infarction, pulmonary oedema, ventricular fibrillation, cardiac arrest or complete AV block) after noncardiac surgery using six clinical factors.

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Method · Limits of application

RCRI/Lee 1999: 6 factors, total 0–6; no automatic recalibration

The original RCRI was derived in stable people aged at least 50 years undergoing major elective noncardiac surgery. Rates are specific to the historical cohorts; they do not automatically calibrate for urgent surgery, other populations or the current hospital. Factor definitions and interpretation must follow the current guideline.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

High-risk surgery (intraperitoneal, intrathoracic or suprainguinal vascular)
Ischemic heart disease (previous myocardial infarction, angina, positive ischemia test, nitrate use or Q wave on ECG)
Heart failure (history, pulmonary edema, paroxysmal nocturnal dyspnea, S3 or congestion on radiograph)
Cerebrovascular disease (stroke or TIA)
Insulin-treated diabetes
Preoperative creatinine > 2.0 mg/dL

3/3 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

One point per factor: high-risk surgery, ischaemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes and creatinine >2.0 mg/dL.

References

Identifier: indice-de-risco-cardiaco-revisado

Original clinical content: Brazilian Portuguese.

Method version

RCRI/Lee 1999: 6 factors, total 0–6; no automatic recalibration

indice-de-risco-cardiaco-revisado@native-2026-10-03+0a9994d9d620

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (3)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

High-risk surgery (intraperitoneal, intrathoracic or suprainguinal vascular): No
Ischemic heart disease (previous myocardial infarction, angina, positive ischemia test, nitrate use or Q wave on ECG): No
Heart failure (history, pulmonary edema, paroxysmal nocturnal dyspnea, S3 or congestion on radiograph): No
Cerebrovascular disease (stroke or TIA): No
Insulin-treated diabetes: No
Preoperative creatinine > 2.0 mg/dL: No

{
  "cir": false,
  "dac": false,
  "icc": false,
  "avc": false,
  "insulina": false,
  "cr": false
}

Expected result

{
  "score": 0,
  "level": "low"
}

Actual result

{
  "score": 0
}

Case 2

reference-002

Inputs

High-risk surgery (intraperitoneal, intrathoracic or suprainguinal vascular): Yes
Insulin-treated diabetes: Yes
Ischemic heart disease (previous myocardial infarction, angina, positive ischemia test, nitrate use or Q wave on ECG): No
Heart failure (history, pulmonary edema, paroxysmal nocturnal dyspnea, S3 or congestion on radiograph): No
Cerebrovascular disease (stroke or TIA): No
Preoperative creatinine > 2.0 mg/dL: No

{
  "cir": true,
  "insulina": true,
  "dac": false,
  "icc": false,
  "avc": false,
  "cr": false
}

Expected result

{
  "score": 2,
  "level": "mid"
}

Actual result

{
  "score": 2
}

Case 3

reference-003

Inputs

High-risk surgery (intraperitoneal, intrathoracic or suprainguinal vascular): Yes
Ischemic heart disease (previous myocardial infarction, angina, positive ischemia test, nitrate use or Q wave on ECG): Yes
Preoperative creatinine > 2.0 mg/dL: Yes
Heart failure (history, pulmonary edema, paroxysmal nocturnal dyspnea, S3 or congestion on radiograph): No
Cerebrovascular disease (stroke or TIA): No
Insulin-treated diabetes: No

{
  "cir": true,
  "dac": true,
  "cr": true,
  "icc": false,
  "avc": false,
  "insulina": false
}

Expected result

{
  "score": 3,
  "level": "high"
}

Actual result

{
  "score": 3
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.