Gupta Score Calculator for Perioperative Risk of MICA

Gupta Perioperative Risk Score

Perioperative myocardial infarction or cardiac arrest (MICA) is associated with significant morbidity and mortality. The Gupta Score for perioperative risk of MICA has been developed to address the limitations of existent risk stratification tools, such as the Revised Cardiac Risk Index.

The original study conducted by Gupta et al. used data from the American College of Surgeons' 2007 National Surgical Quality Improvement Program multicenter database.

Five predictors of perioperative myocardial infarction or cardiac arrest were identified: type of surgery, dependent functional status, abnormal creatinine, American Society of Anesthesiologists' class, and increasing age. The variables awarded to each type of factor can be found in the table below.

Risk of myocardial infarction or cardiac arrest (MICA), intraoperatively or up to 30 days post-op is computed via:

Cardiac risk (%) = ex / (1 + ex)

Where: x = −5.25 + sum of the values of the selected variables.

MICA Risk Percentiles

It was found that the predictive performance of the Gupta Score (C statistic of 0.874) surpasses that of the RCRI (C statistic of 0.747) in lower-risk patients. However, due to the retrospective validation of the study, suspicions that is underestimates myocardial ischemia in patients with elevated risk exist.

In the original study, the primary end point was intraoperative/postoperative MI or CA through 30 days after surgery. The secondary end point in the study was intraoperative/postoperative MICA among patients undergoing aortic or noncardiac vascular surgery.

CA and MI definitions were those of the NSQUIP where cardiac arrest is the absence of cardiac rhythm or presence of chaotic cardiac rhythm that results in loss of consciousness requiring the initiation of any component of basic and/or advanced cardiac life support.

Myocardial infarction was defined as presence of one of the following:

• Documentation of electrocardiogram (ECG) changes indicative of acute MI (ST elevation >1 mm in two or more contiguous leads and/or new left bundle branch and/or new Q-wave in two or more contiguous leads)
• New elevation in troponin greater than 3 times upper level of the reference range in the setting of suspected myocardial ischemia.

The Gupta Score may be used to stratify patients who could benefit from post-surgical cardiac monitoring. High risk patients may require additional cardiovascular evaluation. The score may also be employed in preoperative counselling and when obtaining patient consent.

References

Original reference & Validation

Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, Esterbrooks DJ, Hunter CB, Pipinos II, Johanning JM, Lynch TG, Forse RA, Mohiuddin SM, Mooss AN. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011; 124(4):381-7.

Other references

Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN; American College of Cardiology; American Heart Association. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014; 64(22):e77-137.

Cohn SL, Fernandez Ros N. Comparison of 4 Cardiac Risk Calculators in Predicting Postoperative Cardiac Complications After Noncardiac Operations. Am J Cardiol. 2018; 121(1):125-130.