Cardiac Risk Index (Goldman Criteria) Calculator

The Cardiac Risk Index was proposed by Goldman et al. as a means of evaluating risk of perioperative complications (cardiac events) in patients undergoing heart surgery.

The Cardiac Risk Index results range from 0 to 53, where the higher the score, the greater the risk for complications:

0-5 Points: Class I 1% Complications
6-12 Points: Class II 7% Complications
13-25 Points: Class III 14% Complications
26-53 Points: Class IV 78% Complications

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1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

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The Goldman Cardiac Risk Index explained

The Cardiac Risk Index was proposed by Goldman et al. in 1977 as a means of evaluating risk of perioperative complications (cardiac events) in patients undergoing heart surgery. A revised version of the cardiac index was further published by Lee et al. in 1999.

The CRI determines the likelihood of perioperative cardiac events and places the patient in a risk class based on the score they obtain to the following criteria:

1. History

Age > 70 years (+5) AND/OR Myocardial infarction within 6 months (+10)

2. Cardiac Exam

Signs of CHF: ventricular gallop or JVD (+11) AND/OR Significant aortic stenosis (+3)

3. Electrocardiogram

Arrhythmia other than sinus or premature atrial contractions (+7) AND/OR 5 or more PVC's per minute (+7)

4. General Medical Conditions

PO2 <60; PCO2 >50; K <3; HCO3 <20; BUN >50; Creatinine >3; elevated SGOT; chronic liver disease; bedridden (+3)

5. Operation

Emergency (+4) AND/OR Intraperitoneal, intrathoracic or aortic (+3)

The Cardiac Risk Index results range from 0 to 53, where the higher the score, the greater the risk for complications:

0-5 Points: Class I 1% Complications;
6-12 Points: Class II 7% Complications;
13-25 Points: Class III 14% Complications;
26-53 Points: Class IV 78% Complications.

Examples of conditions considered as major cardiac events MACEs or complications, include:

Myocardial infarction;
Primary cardiac arrest;
Ventricular fibrillation;
Complete heart block;
Pulmonary edema.

The spectrum of peri and post-operative complications does not end with cardiac events, and other complications such as cerebrovascular disease or anemia can occur.

About the original study

Goldman et al. set out to determine which preoperative factors might affect the development of cardiac complications after major noncardiac operations. The study involved a cohort of around 1000 patients over 40 years of age.

By multivariate discriminant analysis, nine independent significant correlates of life-threatening and fatal cardiac complications were identified and four classes of risk described. 10 of the 19 postoperative cardiac fatalities occurred in the 18 patients at highest risk.

References

Original reference

Goldman L, Caldera DL, Nussbaum SR, et. al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N. Engl J Med. 1977;297:845.

Other references

Michel LA, Jamart J, Bradpiece HA, Malt RA. Prediction of risk in noncardiac operations after cardiac operations. J Thorac Cardiovasc Surg. 1990;100(4):595-605.

Goldman L, Caldera DL, Southwick FS, Nussbaum SR, Murray B, O'Malley TA, Goroll AH, Caplan CH, Nolan J, Burke DS, Krogstad D, Carabello B, Slater EE. Cardiac risk factors and complications in non-cardiac surgery. Medicine (Baltimore). 1978;57(4):357-70.

Pinaud M. Evaluation of the cardiac risks in non-cardiac surgery in patients with heart failure. Arch Mal Coeur Vaiss. 2002;95 Spec 4(5 Spec 4):21-6.

Cardiac Risk Index (Goldman Criteria)

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History

Cardiac Exam

Electrocardiogram

General Medical Conditions

Operation