Revised Cardiac Index Calculator

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Revised Cardiac Risk Index (RCRI) Calculator

Use this tool to estimate the risk of major adverse cardiac events (MACE) in patients undergoing non-cardiac surgery. Please check all that apply.

function calculateRCRI() { var score = 0; if (document.getElementById('highRiskSurg').checked) score++; if (document.getElementById('ischemicHeart').checked) score++; if (document.getElementById('heartFailure').checked) score++; if (document.getElementById('cerebrovascular').checked) score++; if (document.getElementById('diabetes').checked) score++; if (document.getElementById('creatinine').checked) score++; var resultDiv = document.getElementById('rcri-result'); var scoreVal = document.getElementById('rcri-score-val'); var classVal = document.getElementById('rcri-class-val'); var riskVal = document.getElementById('rcri-risk-val'); resultDiv.style.display = 'block'; scoreVal.innerHTML = 'Total RCRI Score: ' + score; if (score === 0) { resultDiv.style.backgroundColor = '#e8f5e9'; classVal.innerHTML = 'Risk Class: I'; riskVal.innerHTML = 'Estimated Risk of MACE: 0.4%'; classVal.style.color = '#2e7d32'; } else if (score === 1) { resultDiv.style.backgroundColor = '#fff9c4'; classVal.innerHTML = 'Risk Class: II'; riskVal.innerHTML = 'Estimated Risk of MACE: 0.9%'; classVal.style.color = '#f9a825'; } else if (score === 2) { resultDiv.style.backgroundColor = '#ffe0b2'; classVal.innerHTML = 'Risk Class: III'; riskVal.innerHTML = 'Estimated Risk of MACE: 6.6%'; classVal.style.color = '#ef6c00'; } else { resultDiv.style.backgroundColor = '#ffcdd2'; classVal.innerHTML = 'Risk Class: IV'; riskVal.innerHTML = 'Estimated Risk of MACE: 11.0%'; classVal.style.color = '#c62828'; } }

Understanding the Revised Cardiac Risk Index (RCRI)

The Revised Cardiac Risk Index, commonly known as Lee's Risk Index, is a validated clinical tool used to predict the risk of major perioperative cardiac complications for patients undergoing non-cardiac surgery. It serves as a cornerstone in preoperative assessment, helping clinicians decide if a patient needs further cardiac testing (like a stress test) before surgery.

The Six Clinical Predictors

The RCRI evaluates six specific risk factors that have been found to be independent predictors of major adverse cardiac events (MACE), which include myocardial infarction, pulmonary edema, ventricular fibrillation, or primary cardiac arrest:

  • High-risk Surgery: Operations involving the abdomen, thorax, or major vascular procedures (excluding carotid endarterectomy).
  • Ischemic Heart Disease: A history of heart attack, stable or unstable angina, or a previous positive stress test.
  • Congestive Heart Failure: Past or present evidence of heart failure, such as pulmonary edema or orthopnea.
  • Cerebrovascular Disease: A history of stroke or "mini-strokes" (TIA).
  • Insulin-Dependent Diabetes: Patients who require insulin injections to manage their blood sugar levels.
  • Renal Insufficiency: A preoperative serum creatinine level exceeding 2.0 mg/dL.

Interpreting Your Results

The score correlates directly with the statistical likelihood of a major cardiac event occurring within 30 days of surgery:

Total Score Risk Class Estimated Risk (MACE)
0 Points Class I 0.4%
1 Point Class II 0.9%
2 Points Class III 6.6%
3+ Points Class IV 11.0%

Practical Example

Consider a 68-year-old patient scheduled for a major abdominal surgery (1 point). They have a history of a previous heart attack (1 point) and take insulin for Type 2 Diabetes (1 point). Their total RCRI Score would be 3, placing them in Class IV with an 11% risk of a major cardiac complication. This score would likely trigger a cardiology consultation and potentially further diagnostic optimization before proceeding to the operating room.

Disclaimer: This calculator is intended for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding preoperative risks.

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