Revised Cardiac Risk Index for Pre-Operative Risk

Estimates risk of cardiac complications after surgery.

High-Risk Surgery

  • Intraperitoneal
  • Intrathoracic
  • Suprainguinal vascular

History of ischemic heart disease

  • History of MI
  • History of positive exercise test
  • Current chest paint considered due to myocardial ischemia
  • Use of nitrate therapy
  • ECG with pathological Q waves

History of congestive heart failure

  • Pulmonary edema, bilateral rales or S3 gallop
  • Paroxysmal nocturnal dyspnea
  • CXR showing pulmonary vascular redistribution

History of cerebrovascular disease

  • Prior TIA or stroke

Pre-operative treatment with insulin

Pre-operative creatinine >2 mg/dL


Source: Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, Burke DS, O'Malley TA, Goroll AH, Caplan CH, Nolan J, Carabello B, Slater EE. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977 Oct 20;297(16):845-50.