Post-op cardiac event: Risk factors

Several risk factors for post-operative cardiac complications after major noncardiac surgery have been identified. Goldman et al. in 1977 published a prospective study of 1001 patients over the age of 40 and identified “nine independent significant correlates of life-threatening and fatal cardiac complications”. The Goldman cardiac risk index emerged this data. Subsequently, several modified risk indices and criteria have been published. Modern day models used to predict post-operative cardiac events include the MICA (myocardial infarction cardiac arrest) calculator, the RCRI (revised cardiac risk index), and the newer ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) surgical risk calculator.  The criteria for MICA and RCRI are listed below. The NISQIP calculator is an online web application that utilizes 22 characteristics and is more comprehensive than the other models.  It can be found here:


Cardiac Anesthesia

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  1. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845–50.
  2. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100:1043.
  3. Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013; 217:833.
  4. Gupta PK, Gupta H, Sundaram A, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation 2011; 124:381.

Defined by:  Charlie Pagels, MD