Gupta Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA)

Gupta MICA Calculator
Age
Functional Status
ASA Class
Creatinine >1.5 mg/dL
Surgery Type
Gupta MICA Score: 0
Gupta 0 – Low Risk
Low risk of perioperative MI or cardiac arrest (<1%).
Predicts risk of MI or cardiac arrest after surgery.

Why Use

Few (<1%) of patients suffer perioperative major cardiac events, but 30-day mortality in this population is high (61%). Identifying higher risk patients who will benefit from pre-operative medical cardiac optimization is important. Also useful in preoperative counseling and discussions of informed consent. Recommended as a validated risk estimation tool by 2014 ACC/AHA guidelines on perioperative cardiac evaluation, alongside the ACS NSQIP risk estimator and the Revised Cardiac Risk Index . May be more accurate than RCRI in lower-risk patients ( Cohn 2018 ).

When to Use

Use in patients undergoing surgery, within 30 days of surgery (pre- or postoperatively). May be used in cardiac or noncardiac procedures.

Formula

Cardiac risk, % = e x / (1 + e x ) Where x = −5.25 + sum of the values of the selected variables. Variable Options Value Age per year of increase Age x 0.02 Functional status Independent 0 Partially dependent 0.65 Totally dependent 1.03 ASA class 1: normal healthy patient −5.17 2: mild systemic disease −3.29 3: severe systemic disease −1.92 4: severe systemic disease that is a constant threat to life* −0.95 5: moribund, not expected to survive without surgery 0 Creatinine Normal (≤1.5 mg/dL, 133 µmol/L) 0 Elevated (>1.5 mg/dL, 133 µmol/L) 0.61 Unknown −0.10 Type of procedure Anorectal −0.16 Aortic 1.60 Bariatric −0.25 Brain 1.40 Breast −1.61 Cardiac 1.01 ENT (except thyroid/parathyroid) 0.71 Foregut or hepatopancreatobiliary 1.39 Gallbladder, appendix, adrenals, or spleen 0.59 Hernia (ventral, inguinal, femoral) 0 Intestinal 1.14 Neck (thyroid/parathyroid) 0.18 Obstetric/gynecologic 0.76 Orthopedic and non-vascular extremity 0.80 Other abdominal 1.13 Peripheral vascular** 0.86 Skin 0.54 Spine 0.21 Non-esophageal thoracic 0.40 Vein −1.09 Urology −0.26 *i.e., patient could die acutely without intervention. **Non-aortic, non-vein vascular surgeries.

Pearls / Pitfalls

Improves on prior perioperative major cardiac event risk calculators for surgical patients by using datasets built on modern standards of care in cardiac event assessment (e.g. troponin vs. CK -based markers), in addition to stratifying risk based on type of planned procedure. The criteria for myocardial ischemia was new troponin elevation >3 times the upper limit of normal, which may exclude some myocardial infarctions. Tends to underestimate cardiac events in patients with elevated risk. Useful in patients undergoing low risk procedures, or who are anticipated to require <2 days admission. Pulmonary edema and complete heart block, outcomes for previous perioperative cardiac risk calculators, were not part of the NSQIP database from which this calculator was derived.

Management

Patients identified as low risk require no further cardiovascular testing, according to ACC/AHA guidelines . Patients identified as high risk may require additional cardiovascular evaluation, including cardiology consultation, stress testing, and/or echocardiogram.

Critical Actions

Patients with known or suspected heart disease (cardiovascular disease, significant valvular disease, symptomatic arrhythmias) should undergo routine preoperative cardiac evaluation if indicated for the proposed surgery.

Advice

May help determine which patients require additional post-surgical cardiac monitoring.

Oh hi there 👋
It’s nice to meet you.

New scoring tools, dose references, and guideline summaries straight to your inbox.

We don’t spam! Read our privacy policy for more info.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *