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% Complications
  • 6-12 Points: Class II 7% Complications
  • 13-25 Points: Class III 14% Complications
  • 26-53 Points: Class IV 78% Complications

1

History

2

Cardiac Exam

3

Electrocardiogram

4

General Medical Conditions

5

Operation

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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

Last Checked: April 30, 2020

Next Review: April 30, 2025