Interpretation
| Result | Meaning |
|---|---|
| ≤ 1% | Low risk: generally proceed without further cardiac testing |
| > 1% | Elevated risk: consider functional capacity, biomarkers or further evaluation per guidelines |
Formula
Risk = e^x / (1 + e^x). x = −5.25 + 0.02 × age + functional status (partially dependent 0.65, totally dependent 1.03) + ASA (1 −5.17, 2 −3.29, 3 −1.92, 4 −0.95, 5 0) + creatinine >1.5 mg/dL 0.61 (unknown −0.10) + procedure (anorectal −0.16, aortic 1.60, bariatric −0.25, brain 1.40, breast −1.61, cardiac 1.01, ENT 0.71, foregut/HPB 1.39, gallbladder/appendix/adrenal/spleen 0.59, hernia 0, intestinal 1.14, neck 0.18, OB/GYN 0.76, orthopedic 0.80, other abdominal 1.13, peripheral vascular 0.86, skin 0.54, spine 0.21, thoracic 0.40, urology −0.26, vein −1.09).
Clinical pearls
- Derived from 211,410 ACS NSQIP patients (c-statistic 0.88), outperforming the RCRI in the same validation data.
- The 2014 ACC/AHA perioperative guideline accepts either the RCRI or NSQIP-based calculators; the 1% threshold separates low from elevated risk.
- The model includes no history of coronary disease, heart failure or stress testing; ASA class carries much of that information.
Examples
gupta mica 70 yo asa 3 independent normal creatinine aortic surgeryperioperative MI or cardiac arrest risk for an 80 year old, ASA 4, totally dependent, creatinine 2.1, bowel resectionmica risk 50F asa 2 independent hernia repair cr normal
FAQ
What is the difference between the Gupta MICA and the RCRI?
The Gupta MICA is a logistic model from NSQIP data that uses age, functional status, ASA class, creatinine and 21 procedure types, and it had better discrimination than the RCRI (0.87 versus 0.75 in validation).
What Gupta MICA risk is considered high?
A predicted risk of perioperative MI or cardiac arrest above 1% is considered elevated risk by the ACC/AHA perioperative guideline.