Updated Review of the Revised Cardiac Risk Index for Pre-Operative Risk

The Revised Cardiac Risk Index (RCRI) estimates the risk of major cardiac events in patients undergoing noncardiac surgery. It was originally derived in 4315 patients (1999) and showed modest discrimination, with similar findings in subsequent validation studies (AUC 0.75). The RCRI remains a simple, validated, and widely used bedside tool recommended by current ACC/AHA perioperative guidelines, though newer models may offer improved accuracy in select populations. The RCRI should always be interpreted in the context of the overall clinical picture, including the patient’s functional capacity, frailty, type and urgency of surgery, and findings from biomarkers or imaging when available.