University of Maryland, Baltimore
The 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Non-cardiac Surgery describes the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Myocardial Infarction and Cardiac Arrest (MICA),?also known as the?Gupta Perioperative Cardiac Risk Calculator, as follows: "The American College of Surgeons NSQIP MICA risk-prediction rule was created in 2011 (115), with a single study—albeit large and multicenter—describing its derivation and validation (). This tool includes adjusted ORs for different surgical sites, with inguinal hernia as the reference group. Target complications were defined as cardiac arrest (defined as “chaotic cardiac rhythm requiring initiation of basic or advanced life support”) or MI (defined as ≥1 of the following: documented electrocardiographic findings of MI, ST elevation of ≥1 mm in >1 contiguous leads, new left bundle-branch block, new Q-wave in ≥2 contiguous leads, or troponin >3 times normal in setting of suspected ischemia). Using these definitions of outcome and chart-based data collection methods, the authors of the risk calculator derived a risk index that was robust in the derivation and validation stages and appeared to outperform the RCRI (which was tested in the same dataset) in discriminative power, particularly among patients undergoing vascular surgery."Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Non-cardiac 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-e137. doi:10.1016/j.jacc.2014.07.944.? Society of Anesthesiologists (ASA) Physical Status Classification System (updated 2014):? This classification system is used an an input for the surgical risk calculators (above): , determination of the Mallampati Score is helpful in determining ease/difficulty of intubation and MAY contribute to predicting OSA (obstructive sleep apnea) risk: ................
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