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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm





    Chief Complaint


    Organ System


    Patent Pending

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

    Predicts risk of MI or cardiac arrest after surgery.


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

    When to Use
    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).

    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)
    Choose one


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    Next Steps
    Creator Insights


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


    • 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