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    Chief Complaint


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    Patent Pending

    Revised Cardiac Risk Index for Pre-Operative Risk

    Estimates risk of cardiac complications after noncardiac surgery.


    Note: this calculator is based on the Lee modification of the original Goldman index for cardiac risk (see Creator Insights for more info from Dr. Goldman).


    Simple score to estimate risk of perioperative cardiac events.


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    Next Steps
    Creator Insights


    Used to judge the benefits and risks of surgery. Decision to have surgery should be based on the total risk judged against the benefit of surgery over the next best option.


    Addition of the selected points:

    Risk factor



    High-risk surgery

    Intraperitoneal; intrathoracic; suprainguinal vascular


    History of ischemic heart disease

    History of myocardial infarction (MI); history of positive exercise test; current chest pain considered due to myocardial ischemia; use of nitrate therapy or ECG with pathological Q waves


    History of congestive heart failure

    Pulmonary edema, bilateral rales or S3 gallop; paroxysmal nocturnal dyspnea; chest x-ray (CXR) showing pulmonary vascular redistribution


    History of cerebrovascular disease

    Prior transient ischemic attack (TIA) or stroke


    Pre-operative treatment with insulin



    Pre-operative creatinine >2 mg/dL / 176.8 µmol/L



    Facts & Figures


    RCRI Score

    Risk of major cardiac event*









    *Defined as myocardial infarction, pulmonary edema, ventricular fibrillation/primary cardiac arrest, or complete heart block.


    Other References

    Research PaperFleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007 Oct 23;50(17):1707-32. Erratum in: J Am Coll Cardiol. 2008 Aug 26;52(9):794-7. Chaikof, Elliott [corrected to Chaikof, Elliott L]. PubMed PMID: 17950159.
    Dr. Lee Goldman

    From the Creator

    Dr. Lee Goldman on original Goldman Cardiac Risk Index for MDCalc:

    The Revised Cardiac Risk Index was published 22 years after the original index became the first multifactorial approach to assessing the cardiac risk of non-cardiac surgery and one of the first such approaches for any common clinical problem. The revision was important because of major changes in the diagnosis of cardiac disease during the intervening years – especially the widespread use of echocardiography and less use of Holter monitoring. As a result, evidence of coronary disease and heart failure replaced prior reliance on the arrhythmias (both atrial and ventricular) that had been very important in the original index. Furthermore, the original index changed practice, so that previously important factors (recent MI, severe aortic stenosis) were rarely represented in the more recent cohort of patients. We had hoped that the Index would not only estimate risk but also help target certain subgroups of patients for specific beneficial interventions. The former goal has been achieved, as numerous studies have validated the Index, even if some have suggested ways to improve it in certain types of patients. The latter goal has been more elusive, since large randomized trials have failed to show benefits from preoperative coronary revascularization or perioperative beta blockade, or by extension the preoperative testing that might refine risk stratification. Whether some high risk subgroups will benefit from any of these strategies remain a subject of debate.

    About the Creator

    Lee Goldman, MD, MPH, is a professor and executive vice president for Health and Biomedical Sciences at Columbia University. He is also the dean of the Faculties of Health Sciences and Medicine at Columbia University Medical Center. Previously, he was a professor, department chair and associate dean at UCSF. Dr. Goldman researches the costs and effectiveness of diagnostic and therapeutic strategies and is well-known for applying the latest methods of multivariate analysis, cost-effectiveness, quality-of-life, and computer-simulation models to key topics in clinical medicine.

    To view Dr. Lee Goldman's publications, visit PubMed

    About the Creator
    Dr. Lee Goldman