Prognosticators of cardiac risk in non-cardiac surgery : a comparative study

ABSTRACT

A prospective study of 369 patients undergoing 375 general surgical operation was undertaken. Goldman cardiac risk index was noted to be the better prognosticator of preoperative cardiac risk in patients undergoing major non-cardiac operations as compared to ASA physical status complication. Goldmans classification avoids the 10% risk of difference of opinion among anesthesiologist and internist in the proper classification of patients. It is an objective assessment supported by clinical data. In poor risk patients, it is selective and sensitive in the sense that it identifies only 9.06% of studied population that needs more intensive hemodynamic monitoring and the care of competent anesthesiologist and cardiologist because of its high mortality rate of 41.17%. It is also observed by ASA physical status classification in the pre-operative evaluation of cardiac risk in surgery. For that reason, It was suggested that the anesthesiologist continue to use the ASA classification while the internist and the surgeon should abandon the ASA and use Goldmans classification instead. Patients evaluated as good risk patients for operation are patients in ASA Class I and II and Class I of Goldman; as fair risk if ASA Class II and Goldman Class II; and as poor risk if ASA Class III and IV and Goldman Class III. Patients in ASA Class V and Goldman Class IV are assessed as very poor risk because of 100% mortality due to all causes. In the absence ot intensive hemodynamic monitoring facilities available patients in ASA Class V and Goldman IV should not be operated even on an emergency basis