Gupta risk calculator (MICA) estimates a patient’s probability of perioperative myocardial infarction or cardiac arrest within 30 days of non-cardiac surgery using a validated NSQIP-derived logistic model. It’s faster and often more discriminative than legacy scores (e.g., RCRI) when you have the five inputs: age, ASA class, functional status, creatinine (>1.5 mg/dL threshold), and procedure category.
Use the tool below to get an instant probability and a clear risk band mapped to guideline thresholds (e.g., “low risk” <1% MACE).
Gupta Risk Calculator
Predicts % risk of perioperative myocardial infarction or cardiac arrest (MICA) within 30 days of surgery using the NSQIP model by Gupta et al. (2011).
risk = e^x / (1 + e^x) with x = 0.02×Age + Functional + ASA + Creat + Procedure − 5.25About this calculator
Sources & notes
- Gupta PK, et al. Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery. Circulation. 2011. (AHA journal page)
- Coefficient table & worked example based on community implementations: Omni Calculator, “Gupta Risk Calculator” (accessed 2025), which reproduces the same formula and coefficients. (omnicalculator.com/health/mica)
- Risk distribution percentiles for MICA (e.g., ≈95th percentile at ~2.6%): Evidencio model page. (evidencio.com/models/show/961)
- Risk-label threshold context: ACC/AHA perioperative guidelines define “low risk” as estimated MACE < 1% and “elevated risk” ≥ 1%. (JACC 2014 guideline)
Note: External validations show performance varies across populations and may require recalibration before clinical use.
Disclaimer
What is the Gupta risk calculator (MICA)?
The Gupta risk calculator (also called NSQIP MICA) predicts the probability of myocardial infarction or cardiac arrest within 30 days after non-cardiac surgery. It was derived and validated on hundreds of thousands of NSQIP cases and published in Circulation (2011). In head-to-head analysis, its predictive performance surpassed RCRI.
The five inputs it needs
- Age (years)
- Functional status (independent, partially dependent, totally dependent)
- ASA class (I–V)
- Creatinine (binary threshold: > 1.5 mg/dL adds risk)
- Procedure category (21 site groups; e.g., aortic, brain, intestinal, orthopedic, vein, etc.)
The math (kept transparent)
Logistic form: risk = e^x / (1 + e^x) wherex = 0.02 × Age + Functional + ASA + Creatinine(+0.61 if >1.5) + Procedure − 5.25.
Those coefficients match the original publication and widely used community implementations.
How to interpret the number
- < 1% → often treated as “low risk” (procedures with MACE <1% are “low risk” in ACC/AHA 2014).
- 1–2.6% → intermediate zone (between the guideline’s low-risk cut and the ~95th percentile of NSQIP MICA).
- ≥ 2.6% → higher relative risk (≥ ~95th percentile in the reference distribution).
Guideline context: Perioperative guidance was updated in 2024 (AHA/ACC et al.). Use clinical judgment, biomarkers, and team-based decision-making instead of fixating on a single score.
Why clinicians still use it
- Parsimonious: 5 routinely available items, no imaging required.
- Performance: Original work reported better discrimination than RCRI; multiple external studies continue to explore its utility across specific surgeries. Translation: it’s pragmatic when you need a probability fast.
Where our calculator is different (your page’s value prop)
- Immediate, readable output with the raw logit
xand exact formula shown for auditability. - Evidence-tied bands (Low / Moderate / Higher) aligned with guideline thresholds and NSQIP percentiles instead of arbitrary colors.
- Quality-of-life features: reset button, keyboard support, and inline Sources + Disclaimer so nobody mistakes probability for a decision.
(That transparency beats black-box widgets and improves trust with faculty, trainees, and clinicians.)
Step-by-step: using the calculator correctly
- Enter Age (years).
- Select Functional status accurately don’t over-call “independent.”
- Pick the correct ASA class from the pre-op note.
- Type Creatinine (use the latest value; threshold is >1.5 mg/dL).
- Choose the Procedure category closest to the planned operation.
- Click Calculate → read % risk and the risk band. If the number challenges your plan, escalate per local policy (pre-op optimization, cardiology consult, biomarkers, etc.).
Limitations (don’t ignore these)
- Calibration drift: Models trained on one era/system can mis-estimate absolute risk elsewhere; recalibration may be needed.
- Not a decision rule: ACC/AHA stress team-based judgment; the model supplements decisions, it doesn’t make them.
- Procedure coding matters: Picking the wrong category skews risk.
- Population fit: Some subspecialty cohorts show variable performance; check local data where possible.
FAQ
Is the Gupta risk calculator the same as the NSQIP Surgical Risk Calculator?
No. NSQIP/ACS has a broader calculator for multiple outcomes; Gupta MICA targets MI or cardiac arrest with 5 variables.
What counts as “low risk”?
ACC/AHA 2014 uses <1% MACE to define low-risk procedures; anything ≥1% is elevated risk and may warrant more evaluation depending on context.
Has guidance changed since 2014?
Yes. The 2024 AHA/ACC update emphasizes a stepwise approach, better use of biomarkers, and shared decision-making. Don’t use any calculator in isolation.
Where can I read the original study?
The 2011 Circulation paper by Gupta et al. describes development and validation on NSQIP data.
References
Gupta PK et al., Circulation 2011 (MICA model). American Heart Association Journals
ACC/AHA 2014 perioperative guideline (defines <1% “low risk”). American Heart Association Journals
AHA/ACC 2024 perioperative update (modern stepwise approach). professional.heart.org
OmniCalculator (community coefficient table/implementation). Omni Calculator
Evidencio (percentile distribution of MICA risk). evidencio.com
PubMed abstract noting MICA outperforms RCRI in original work; recent specialty-cohort validations. PubMed