Are you looking for a tool to assess a patient's risk of cardiac incident in the perioperative period? This Gupta risk calculator functions as a cardiac arrest and myocardial infarction risk calculator, as well as determining a person's individual need for closer cardiac monitoring.

The article below contains some information on the Gupta cardiac risk formula, Gupta score interpretation, and practical application of this Gupta perioperative risk calculator.

What is Gupta perioperative risk?

Gupta perioperative risk calculator serves as a tool for calculating a patient's risk of a cardiac event - defined here as Myocardial Infarction or Cardiac Arrest (MICA).

It's applies to patients in the perioperative period, that is during surgery or 30 days after it. The important thing to remember is that we don't only mean cardiac surgeries, but also any other non-cardiac surgery.

The tool takes into consideration the general well-being of the patient, their age, kidney function and how difficult the surgery is. Interestingly, it does not take into account some myocardial infarction risk factors, such as LDL levels or smoking status, which are critical in estimating cardiovascular disease risk.

The result helps identify those patients who need their cardiac functions monitored more carefully by physicians and nurses.

Gupta score in medical practice

As we mentioned above, patients that this Gupta risk calculator determines are at high risk require additional monitoring during and after surgery. In this case monitoring mean echocardiogram, stress testing, ECG, and a consultation with a cardiologist.

On the other hand, those at low risk don't need any additional cardiac tests after surgery, as their result is below 50% of the population.

Gupta risk calculator

The formula for determining the risk of myocardial infarction or cardiac arrest is:

cardiac risk [%] = ex / (1 + ex),

where:

x = age * 0.02 + status + asa + creatinine + type - 5.25,

so, x depends on five variables, the values for which are given in brackets below:

  1. Age in years, multiplied by 0.02
  2. Status of a patient:
    • Totally independent (0)
    • Partially dependent (0.65)
    • Totally independent (1.03)
  3. ASA Class
    • Class 1: healthy (-5.17)
    • Class 2: mild systemic disease (-3.29)
    • Class 3: severe systemic disease (-1.92)
    • Class 4: a severe systemic disease that puts a patient's life at risk of death (-0.95)
    • Class 5: moribund, not expected to survive without surgery (0)
  4. Creatinine levels
    • Normal (≤1.5 mg/dL, 133 µmol/L (0)
    • Elevated (>1.5 mg/dL, 133 µmol/L (0.61)
  5. Type of surgery
    • Hernia: ventral, inguinal, femoral, and other (0)
    • Anorectal: anus and rectum (-0.16)
    • Aortic (1.6)
    • Bariatric (-0.25)
    • Brain (1.4)
    • Breast (-1.61)
    • Cardiac: Heart (1.01)
    • ENT, except thyroid and parathyroid (0.71)
    • Foregut/hepato-pancreaticobiliary: esophagus, stomach, duodenum, pancreas, liver, and biliary tree (except isolated cholecystectomy) (1.39)
    • Gallbladder, appendix, adrenals, spleen, biliary tree surgeries other than cholecystectomy not included (0.59)
    • Intestinal, below the level of the duodenum (1.14)
    • Neck, including thyroid and parathyroid (0.18)
    • Obstetric or gynecologic (0.76)
    • Orthopedic (0.8)
    • Abdomen, other (1.13)
    • Peripheral vascular, nonaortic, nonvein vascular surgeries (0.86)
    • Skin (0.54)
    • Spine (0.21)
    • Thoracic, except esophageal and cardiac (0.4)
    • Vein (-1.09)
    • Urology, kidneys and urinary system (-0.26)

Remember that those are not the only myocardial infarction risk factors. Still, we regard them as the ones with the most impact on MICA risk in patients undergoing any (non-cardiac) surgery.

How to interpret the Gupta risk calculator?

After we have the outcome of the calculation, we ought to read how it correlates to the results of 'Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery', the study the Gupta risk calculator is based on. The scientists who wrote it used percentiles to demonstrate the distribution of the MICA risk among surgical patients.

MICA Risk
Percentile
<0.05%
<25th
0.05-0.14%
26th - 50th
0.14-1.47%
51st - 90th
1.47-2.60%
91st - 95th
2.60-7.69%
96th - 97th
>7.69%
>97th

Patients at a high risk of myocardial infarction or cardiac arrest present a Gupta score above 1%. They will certainly need additional cardiac evaluation after surgery.

Gupta cardiac risk calculations in practice

Let's work on an example. Caroline is a 76-year-old woman who needs a hip prosthesis. She needs some help from her carer when taking care of the house due to her severe systemic diseases. Her creatinine levels are still normal, reaching 1 mg/dL. As she has some myocardial infarction risk factors, the physician decides to estimate her overall risk of an incident during and after the surgery.

What is her MICA (Gupta cardiac risk)?

  • Age: 76 years (76)
  • Status: Partially dependent (0.65)
  • ASA: Class 3 (-1.92)
  • Creatinine 1 mg/dL (0)
  • Type of procedure: Orthopedic (0.8)

x = 0.76 * 0.02 + 0.65 + (-1.92) + 0 + 0.8 - 5.25

x= -4.2

Therefore,

cardiac risk [%] = e-5.7 / (1 + e-5.7)

cardiac risk [%] = 1.48 %

Her Gupta score places between 90th and 95th percentile; thus, the risk of myocardial infarction or cardiac arrest after the hip prosthesis implantation surgery is high. Caroline will need an extended cardiac evaluation in the postoperative period.

Dominika Miszewska, PhD candidate