This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
In 1977, Lee Goldman and colleagues at Massachusetts General Hospital published the first multifactorial index of cardiac risk in noncardiac surgery, based on 1,001 patients. The Goldman cardiac risk index weighs nine factors to estimate the risk of serious cardiac complications (heart attack, pulmonary edema, ventricular tachycardia) and cardiac death around surgery.
The nine factors
| Factor | Points |
|---|---|
| S3 gallop or jugular venous distension (heart failure) | 11 |
| Heart attack in the last 6 months | 10 |
| Rhythm other than sinus, or premature atrial contractions | 7 |
| More than 5 premature ventricular beats per minute before surgery | 7 |
| Age over 70 | 5 |
| Emergency surgery | 4 |
| Intraperitoneal, intrathoracic or aortic surgery | 3 |
| Significant aortic stenosis | 3 |
| Poor general condition | 3 |
Poor general condition means any of: PaO2 below 60 or PaCO2 above 50 mmHg, potassium below 3 or bicarbonate below 20 mmol/L, BUN above 50 or creatinine above 3 mg/dL, abnormal liver tests or chronic liver disease, or being bedridden from a noncardiac cause.
Classes
| Class | Points | Serious complications | Cardiac deaths |
|---|---|---|---|
| I | 0 to 5 | 0.7% | 0.2% |
| II | 6 to 12 | 5% | 2% |
| III | 13 to 25 | 11% | 2% |
| IV | 26 or more | 22% | 56% |
Example
A 74-year-old (5 points) having abdominal surgery (3 points), with no other factor, scores 8 points: class II, with serious cardiac complications in about 5% of similar patients in the original study.
Goldman or RCRI?
The Goldman index was replaced in daily practice by the simpler Revised Cardiac Risk Index (Lee, 1999), which uses six factors including diabetes on insulin and kidney function. Current American and European guidelines use the RCRI or the NSQIP calculators, together with functional capacity (being able to climb two flights of stairs) and, in selected patients, biomarkers such as BNP or troponin. The Goldman index remains useful to understand where perioperative risk assessment comes from and appears in many exams.
Limits
The index predates modern anesthesia, beta blockers, statins and coronary stenting, so its absolute risks overestimate today’s figures. Decisions about testing, delaying surgery or adjusting treatment belong to the anesthesiologist and the surgical team.