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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

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

    Predicts risk of MI or cardiac arrest after surgery.

    INSTRUCTIONS

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

    When to Use
    Pearls/Pitfalls
    Why Use

    • Use in patients undergoing surgery, within 30 days of surgery (pre- or postoperatively).

    • May be used in cardiac or noncardiac procedures.

    • 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.

    • 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).

    years
    Independent
    Partially dependent
    Totally dependent
    1: normal healthy patient
    2: mild systemic disease
    3: severe systemic disease
    4: severe systemic disease that is a constant threat to life (i.e., patient could die acutely without intervention)
    5: moribund, not expected to survive without surgery
    Normal (≤1.5 mg/dL, 133 µmol/L)
    Elevated (>1.5 mg/dL, 133 µmol/L)
    Unknown
    Choose one

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Prateek K. Gupta

    About the Creator

    Prateek K. Gupta, MD, is a vascular surgeon at Methodist University Hospital in Memphis, Tennessee. He is also an assistant professor of surgery at the University of Tennessee. Dr. Gupta's primary research is focused on surgical outcomes.

    To view Dr. Prateek K. Gupta's publications, visit PubMed

    Are you Dr. Prateek K. Gupta? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Alice Race, MD
    About the Creator
    Dr. Prateek K. Gupta
    Are you Dr. Prateek K. Gupta?
    Content Contributors
    • Alice Race, MD