Goldman cardiac risk index
Pro Research Analysisby 
Searched over 200M research papers
Overview of the Goldman Cardiac Risk Index for Noncardiac Surgery
The Goldman Cardiac Risk Index (CRI) is a widely used tool for assessing the risk of major adverse cardiac events (MACEs) in patients undergoing noncardiac surgery. These events include myocardial infarction, cardiac arrest, heart failure, and arrhythmias, which collectively account for a significant proportion of postoperative complications and deaths. Accurate risk stratification is essential for identifying patients who may benefit from preventive strategies and tailored perioperative management, while also avoiding unnecessary preoperative testing in low-risk individuals .
Validation and Predictive Value of the Goldman Index
Multiple studies have confirmed the reliability and validity of the Goldman CRI in predicting perioperative cardiac events. In a prospective study of over 1,100 patients, the incidence of cardiac events increased with higher Goldman risk classes: 0.7% in class I, 3% in class II, 15% in class III, and 30% in class IV, demonstrating a clear correlation between the index score and postoperative risk . Similar findings were observed in patients undergoing high-risk vascular procedures, where those in higher Goldman classes had significantly greater rates of perioperative complications 34.
Comparison with Other Cardiac Risk Assessment Tools
The Goldman Index has been compared with other risk assessment methods, such as the American College of Cardiology/American Heart Association (ACC/AHA) guidelines and the Lee index. Some studies suggest that the ACC/AHA guidelines may offer slightly better predictive accuracy, particularly in certain populations, but the Goldman Index remains a simple and effective tool for initial risk stratification . Other research has found that the Goldman Index performs similarly to other indices, such as the Detsky and Larsen indices, with no significant differences in predictive accuracy 89.
Limitations and Population-Specific Considerations
While the Goldman Index is generally effective, its predictive value may vary depending on the patient population and type of surgery. For example, in female patients undergoing elective vaginal surgery, the index was not a significant predictor of perioperative cardiac morbidity, whereas hypertension and ischemic heart disease were more relevant risk factors in postmenopausal women . Additionally, differences in study methodology, patient selection, and outcome definitions can affect the observed performance of the index in validation studies .
Enhancing Risk Stratification with Additional Assessments
Combining the Goldman Index with other diagnostic tools, such as echocardiography or radionuclide imaging, can improve risk stratification, especially in high-risk patients. For instance, adding echocardiographic measures of left ventricular function or MUGA scan findings to the Goldman score can further identify patients at increased risk for cardiac complications 34.
Impact on Long-Term Outcomes
The Goldman Index not only predicts immediate perioperative risk but also correlates with long-term survival after major surgeries such as abdominal aortic aneurysm repair. Patients in higher Goldman classes have significantly lower five-year survival rates, highlighting the index’s value in identifying individuals with poorer long-term prognoses .
Clinical Significance and Practical Application
Incorporating the Goldman Cardiac Risk Index into preoperative assessment algorithms helps clinicians make informed decisions about further testing, perioperative monitoring, and optimization strategies. This approach can reduce unnecessary consultations and testing, streamline perioperative care, and potentially improve patient outcomes 19.
Conclusion
The Goldman Cardiac Risk Index is a validated, practical tool for assessing perioperative cardiac risk in patients undergoing noncardiac surgery. While its predictive accuracy may vary by population and surgical context, it remains a cornerstone of preoperative cardiac evaluation and can be enhanced by combining it with other clinical and diagnostic assessments. Proper use of the index supports individualized patient care and helps reduce the incidence of major cardiac complications.
Sources and full results
Most relevant research papers on this topic