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RCRI: Major adverse cardiac event

The RCRI (Revised Cardiac Risk Index) is used to assess the risk of MACE (Major Adverse Cardiac Events) during surgery, and includes 6 criteria to estimate this risk. These criteria are the presence or history of:

1. Ischemic heart disease

2. Heart failure

3. Cerebral vascular disease

4. Diabetes mellitus

5. Creatinine of 2 or more

6. Intrathoracic, intra-abdominal, or supra-inguinal vascular surgery

0, 1, 2, or 3 of these criteria being met correlate with risk of 0.5%, 1.3%, 4%, and 9% risk of MACE. Meeting 2 or more criteria is considered increased risk of MACE, and pharmacologic stress testing should be considered for nonurgent surgery (especially if patient cannot function at 4 METs [metabolic equivalents]).

One way to remember: “In a Stroke (CVA) of genius, Debbie (diabetes) Created 2 (creatinine of 2, also 2 criteria is increased risk) HeartFelt (heart failure) Schemes (ischemic heart) to find a buff man with abs (chest, abdomen).”


  1. Tateosian VS, Richman DC. Preoperative Cardiac Evaluation for Noncardiac Surgery. Anesthesiol Clin. 2018;36:509-21. doi: 10.1016/j.anclin.2018.07.003. PubMed Link