Cardiac Risk Index (Goldman Criteria)
Assesses risk of perioperative cardiac complications in heart surgery patients.
Refer to the text below the calculator for more information on the Cardiac Risk Index.
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% Complications6-12 Points
: Class II 7% Complications13-25 Points
: Class III 14% Complications26-53 Points
: Class IV 78% Complications
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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.
Specialty: Cardiology
System: Cardiovascular
Objective: Screening
Type: Index
No. Of Items: 5
Year Of Study: 1977
Article By: Denise Nedea
Published On: April 30, 2020 · 12:00 AM
Last Checked: April 30, 2020
Next Review: April 30, 2025