Healthcare & Clinical
Revised Cardiac Risk Index (Lee RCRI) Preoperative MACE Score Formula
Calculate Thomas Lee’s ACC/AHA/CCS-endorsed 0–6 Revised Cardiac Risk Index (High-Risk Surgery, Ischemic Heart Disease, Heart Failure, Cerebrovascular Disease, Pre-op Insulin, Creatinine > 2.0 mg/dL) and Duceppe 30-day perioperative MACE risk (%).
Estimate 30-day perioperative myocardial infarction, cardiac arrest, or death before noncardiac surgery!
Before elective hip arthroplasty, colectomy, or vascular surgery, anesthesiologists and internists stratify cardiac risk using Thomas Lee’s (1999, Circulation) 6-predictor Revised Cardiac Risk Index (RCRI)—endorsed by ACC/AHA, ESC, and Canadian Cardiovascular Society (CCS) perioperative guidelines! Each predictor awards +1 point (range 0 to 6): (1) High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular), (2) History of ischemic heart disease (prior MI, positive stress test, angina/nitrate use, or pathologic Q waves), (3) History of congestive heart failure, (4) History of cerebrovascular disease (stroke or TIA), (5) Preoperative insulin therapy for diabetes, and (6) Preoperative serum creatinine > 2.0 mg/dL (> 177 umol/L).
Emmanuelle Duceppe et al. (2017, CMAJ / CCS Guidelines) recalibrated 30-day Major Adverse Cardiac Event (MACE: death, MI, or cardiac arrest) rates in the modern high-sensitivity troponin surveillance era: RCRI 0 points = 3.9%, 1 point = 6.0%, 2 points = 10.1%, and >= 3 points = 15.0% (where RCRI >= 1 in patients >= 45 yr—or any patient >= 65 yr—triggers pre-op BNP/NT-proBNP and postoperative troponin monitoring under CCS guidelines, and RCRI >= 2 defines Elevated Risk >= 1% MACE under ACC/AHA guidelines)!
| Lee RCRI Total Score (0 to 6) | Original 1999 CK-MB Risk | Modern Troponin-Era 30-Day MACE (CCS 2017) | Perioperative Guideline Action |
|---|---|---|---|
| 0 Points | 0.4% | 3.9% | Low Risk — Proceed Without Routine Stress Testing |
| 1 Point | 0.9% | 6.0% | Intermediate — Proceed if >= 4 METs (Consider BNP) |
| 2 Points | 6.6% | 10.1% | Elevated Risk — Assess Functional Capacity (METs) / BNP |
| >= 3 Points (3 to 6) | 11.0% | 15.0% | High Perioperative Cardiac Risk — Multidisciplinary Optimization |
Total Lee Revised Cardiac Risk Index (0 to 6 Points)
Sums the five binary clinical history/surgery predictors (B2:B6) plus +1 if preoperative serum creatinine B7 > 2.0 mg/dL.
=IF(B7 <= 0, "Invalid Creatinine", IF(B2 = 1, 1, 0) + IF(B3 = 1, 1, 0) + IF(B4 = 1, 1, 0) + IF(B5 = 1, 1, 0) + IF(B6 = 1, 1, 0) + IF(B7 > 2, 1, 0))CCS / Duceppe (2017) Predicted 30-Day Perioperative MACE Risk (%)
Maps RCRI 0, 1, 2, and >= 3 points to contemporary troponin-era 30-day MACE incidence (3.9%, 6.0%, 10.1%, 15.0%).
=IF(B7 <= 0, "Invalid Creatinine", IF((SUM(B2:B6) + IF(B7 > 2, 1, 0)) >= 3, 15, IF((SUM(B2:B6) + IF(B7 > 2, 1, 0)) = 2, 10.1, IF((SUM(B2:B6) + IF(B7 > 2, 1, 0)) = 1, 6, 3.9))))Try the example
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