Revised Cardiac Risk Index
In 1977 Goldman, et al., developed the first cardiac risk index for patients above 40 years of age about to be operated by looking at nine variables which increased the risk of perioperative cardiac complications.[1] Goldman et al then created a revision called the Revised Cardiac Risk Index (RCRI).[2] These variables are
- preoperative third heart sound or jugular venous distention
- myocardial infarction in the preceding six months
- more than five premature ventricular contractions per minute documented at any time before operation
- cardiac rhythm other than sinus rhythm or presence of premature atrial contractions on preoperative electrocardiogram
- age over 70 years
- intraperitoneal, intrathoracic or aortic operation
- emergency operation
- important aortic valvular stenosis
- poor general medical condition
Since 1977, multiple cardiac risk indices and guidelines for preoperative cardiac evaluation have been developed. One option is the Surgical Mortality Probability Model(S-MPM)[3]; however, the authors of the RCRI have discussed the differences in the two approaches.[4]
Goldman’s Cardiac Risk Index
| PATIENT RISK FACTORS | POINTS |
|---|---|
| Third heart sound or jugular venous distention | 11 |
| Recent myocardial infarction | 10 |
| Nonsinus rhythm or premature atrial contraction on electrocardiogram | 7 |
| >5 premature ventricular contractions | 7 |
| Age >70 yr | 5 |
| Emergency operations | 4 |
| Poor general medical condition | 3 |
| Intrathoracic, intraperitoneal, or aortic surgery | 3 |
| Important valvular aortic stenosis | 3 |
For noncardiac surgery, the risk of cardiac complications are: • 0-5 points = 1% risk • 6-12 points = 7% risk • 13-35 points = 14% risk • >26 points = 78% risk (Adapted from Akhtar S, Silverman DG. Assessment and management of patients with ischemic heart disease. Crit Care Med 2004;32:S126–36.)
See also
References
- ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 904659, please use {{cite journal}} with
|pmid=904659instead. - ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 10477528, please use {{cite journal}} with
|pmid=10477528instead. - ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 22418007, please use {{cite journal}} with
|pmid=22418007instead. - ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 22354985 , please use {{cite journal}} with
|pmid=22354985instead.Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1161/CIRCULATIONAHA.111.072132 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with|doi=10.1161/CIRCULATIONAHA.111.072132instead.
