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    Patent Pending

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

    Predicts risk of MI or cardiac arrest after surgery.
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    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

    Advice

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

    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.

    Content Contributors
    • Alice Race, MD
    Reviewed By
    • Ram Kolachalam, MD
    About the Creator
    Dr. Prateek K. Gupta
    Are you Dr. Prateek K. Gupta?
    Content Contributors
    • Alice Race, MD
    Reviewed By
    • Ram Kolachalam, MD