Goldman et al.
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
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.
Back to BBAC Protocol by Art Wallace, MD PhD