Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures

Lee Goldman, Debra L. Caldera, Samuel R. Nussbaum, Frederick S. Southwick, Donald Krogstad, Barbara Murray, Donald S. Burke, Terrence A. O'malley, Allan H. Goroll, Charles H. Caplan, James Nolan, Blase Carabello, Eve E. Slater

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1905 Scopus citations


To determine which preoperative factors might affect the development of cardiac complications after major noncardiac operations, we prospectively studied 1001 patients over 40 years of age. By multivariate discriminant analysis, we identified nine independent significant correlates of life-threatening and fatal cardiac complications: 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; rhythm other than sinus or presence of premature atrial contractions on preoperative electrocardiogram; age over 70 years; intraperitoneal, intrathoracic or aortic operation; emergency operation; important valvular aortic stenosis; and poor general medical condition. Patients could be separated into four classes of significantly different risk. Ten of the 19 postoperative cardiac fatalities occurred in the 18 patients at highest risk. If validated by prospective application, the multifactorial index may allow preoperative estimation of cardiac risk independent of direct surgical risk. (N Engl J Med 297:845–850, 1977) The most widely used technic for the preoperative assessment of surgical risk, the Dripps-American Surgical Association,1,2 is an excellent predictor of perioperative noncardiac complications3 but not necessarily of perioperative cardiac problems.4 Existing data have shown that a recent preoperative myocardial infarction5 6 7 8 and most other signs and symptoms of cardiac disease9 correlate with overall surgical and usually with specific cardiac risk, but these reports have been limited to univariate analysis and are from before the present era of widespread cardiac surgery. The present study attempts a multifactorial approach to the estimation of cardiac risk in noncardiac surgical procedures. Materials and Methods.

Original languageEnglish (US)
Pages (from-to)845-850
Number of pages6
JournalNew England Journal of Medicine
Issue number16
StatePublished - Oct 20 1977
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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