RCRI (Lee Score)

Underestimates risk in vascular surgery. Does not account for preoperative NTproBNP or troponin elevation, which independently predict MACE. Consider adding biomarker assessment in high-RCRI patients.

Thomas H. Lee derived the RCRI (also called the Lee Index) as a revision of Goldman's original Cardiac Risk Index (1977). The Lee score reduced the Goldman criteria from 9 to 6 factors and significantly improved predictive accuracy. It remains the ACC/AHA-endorsed perioperative risk calculator and the global standard for preoperative cardiac assessment.