Gupta Perioperative Risk for MI or Cardiac Arrest (MICA)
Predicts risk of perioperative myocardial infarction or cardiac arrest. Based on 5 factors. More precise than RCRI for non-cardiac surgery.
Score interpretation
Low perioperative cardiac risk (<1% MICA risk).
→ Standard perioperative monitoring. No additional cardiac workup required.
Moderate risk (1–5% MICA risk).
→ Pre-operative cardiology review. Optimise medical therapy. Consider cardiac investigations if clinically appropriate.
High risk (>5% MICA risk).
→ Cardiology review mandatory. Consider postponing elective surgery. Shared decision-making with patient. High-dependency perioperative care.
Interpretation bands for the Gupta MICA. Apply clinical judgement and local guidance.
References
- Gupta PK et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124(4):381-387.
Related
Curated clinical cross-links plus same-class fallbacks.
- POSSUM Score for Surgical Morbidity and Mortality · Perioperative Risk
- SORT (Surgical Outcome Risk Tool) · Perioperative Risk
- Revised Cardiac Risk Index (RCRI / Lee Index) · Perioperative Risk
- ASA Physical Status Classification · Perioperative Risk
- Cardiovascular Risk in Orthotopic Liver Transplantation (CAR-OLT) Score · Perioperative Risk
- SORT — Surgical Outcome Risk Tool · Perioperative Risk
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Rivaroxaban (Perioperative VTE Prophylaxis) · Direct Oral Anticoagulant — VTE Prophylaxis Post-Surgery
- Aprotinin · Antifibrinolytic — Cardiac Surgery
- Protamine Sulphate · Heparin Antidote — Vascular / Cardiac Surgery
- Amiodarone (IV — ICU/Peri-Arrest) · Antiarrhythmic (Class III)
- Lidocaine IV (Cardiac Arrhythmia) · Antiarrhythmic
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.