Revised Cardiac Risk Index

The Revised Cardiac Risk Index (RCRI) helps healthcare providers figure out your risk of heart complications like a heart attack, cardiac arrest or even death after the stress of surgery. It’s a simple tool they use before you have an operation on an area other than your heart.

The risk factors in the Revised Cardiac Risk Index are:

• Upcoming high-risk surgery, like having an operation on an organ in your chest
• History of heart disease that limits blood flow (heart attack or angina)
• History of heart failure or low ejection fraction (percent of blood your left ventricle can pump)
• History of stroke or transient ischemic attack (TIA)
• Diabetes you manage with insulin
• Chronic kidney disease

A provider calculates your RCRI score by giving you one point for each of the above risk factors. If you don’t have any risk factors or you have only one, you may not need to do any testing before surgery. If you have two or more risk factors, you may need tests.

Why is it done?

Healthcare providers use the Revised Cardiac Risk Index to decide whether you’re at a higher risk for major heart complications after surgery.

The RCRI risk calculator may be most helpful if your case isn’t simple. It may be an easy decision for a provider to proceed with a simple operation on a young person with no risk factors. If you’re clearly at high risk for heart problems and surgery can wait, your provider will likely want to address the heart issues first.

If you have some risk factors, this cardiac risk assessment can help your provider decide if you need testing. Surgery puts stress on your body. Your provider wants to be sure your body can handle it.

Using an RCRI score to predict the risk of death after surgery can tell providers who to consider high-risk before surgery. This can apply to elective or emergency operations. Providers can use the Revised Cardiac Risk Index score to choose a less invasive surgical approach. They may also find out who they can expect to need a higher level of care and longer hospital stays after surgery.

How does the Revised Cardiac Risk Index work?

The RCRI risk calculator assigns one point for each risk factor you have. With one or zero risk factors (points), your risk for a complication related to your heart is below 1%. Two risk factors or points raise your risk of a heart complication to nearly 7%. Three or more risk factors or points estimate your risk at 11%.

The index is a collection of information about your health. You don’t need physical tests. It’s just about answering questions. This is what makes it a simple test to use anywhere, even in a hospital room or emergency department.

What are the limitations of the Revised Cardiac Risk Index?

An RCRI score may be less accurate in people who are going to have a major vascular (blood vessel) operation. Also, online surgical databases can offer better risk estimates. This is because they draw from actual results from similar procedures at hundreds of hospitals.

What can I expect after the Revised Cardiac Risk Index?

You’ll be able to go ahead with surgery if you’re low risk. If the index says you’re high-risk, you’ll likely have more tests to give your healthcare team more information.

What type of results do you get and what do the results mean?

Your healthcare provider may talk about your cardiac surgical risk calculator results by risk class:

• Class I has no risk factors
• Class II has one risk factor
• Class III has two risk factors
• Class IV has three or more risk factors

If I’m high risk, what are the next steps?

If your provider tells you you’re in Class III or IV, you may need to have tests. They may also need to put extra focus on working to reduce complications. They may postpone or cancel surgery until they can fix the problems that put you at risk of heart issues.

You may need these tests:

• Electrocardiogram (EKG)
• Echocardiogram
• Chest X-ray
• Stress test
• Blood tests to confirm that you have heart failure or had a heart attack
• Coronary angiogram

When should I call my doctor?

Contact your healthcare provider if you have questions about any tests you need. They can tell you how to prepare for them and what to expect.