MIRACLE2 Score Compared With Downtime and Current Selection Criterion for Invasive Cardiovascular Therapies After OHCA

Aldous, R; Roy, R; Cannata, A; Abdrazak, M; Mohanan, S; Beckley-Hoelscher, N; Stahl, D; Kanyal, R; Kordis, P; Sunderland, N; Parczewska, A; Kirresh, A; Nevett, J; Fothergill, R; Webb, I; Dworakowski, R; Melikian, N; Kalra, S; Johnson, TW; Sinagra, G; Rakar, S; Noc, M; Patel, S; Auzinger, G; Gruchala, M; Shah, AM; Byrne, J; MacCarthy, P; Pareek, N

doi:10.1016/j.jcin.2023.08.010

Acute cardiac care & resuscitation

MIRACLE2 Score Compared With Downtime and Current Selection Criterion for Invasive Cardiovascular Therapies After Out-of-hospital Cardiac Arrest (OHCA)

JACC Cardiovasc IntervPublished 21 Aug 2023Retrospective cohort study

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Authors' conclusion

The MIRACLE2 score has superior prediction of outcome after OHCA than downtime and higher discrimination of poor outcome than the current RCT recruitment criteria.

Study context

Population: Patients after OHCA, European Cardiac Arrest Registry (EUCAR), May 2012–September 2022
Participants: 1,259 patients

Exposure: MIRACLE2 score vs downtime and current randomized controlled trial (RCT) recruitment criteria
Outcome: Poor neurologic outcome (cerebral performance category 3-5)
Follow-up: Hospital discharge

Methodological detailsmulticentre (6 centres), registry-based

Multicentre (6 centres)
Registry-based

Main finding

As reported in the abstract

Discrimination for poor neurologic outcome

Group	AUC
MIRACLE2	0.877 (95% CI: 0.854-0.897)
Zero flow	0.610 (95% CI: 0.577-0.642)
Low flow	0.725 (95% CI: 0.695-0.754)
Total downtime	0.732 (95% CI: 0.701-0.760)

AUC

MIRACLE20.877 (95% CI: 0.854-0.897)

Zero flow0.610 (95% CI: 0.577-0.642)

Low flow0.725 (95% CI: 0.695-0.754)

Total downtime0.732 (95% CI: 0.701-0.760)

Observational data: associations, not effects.

Further findings

Association with poor outcome (multivariable logistic regression)

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
MIRACLE2	0.20.5125	2.23 (1.98–2.51)	P < 0.0001
Zero flow	0.20.5125	1.07 (1.01–1.13)	P = 0.013
Low flow	0.20.5125	1.04 (0.99–1.09)	P = 0.054
Total downtime	0.20.5125	0.99 (0.95–1.03)	P = 0.52
	0.20.5125Odds ratio (log scale)

Outcome	Values
Poor outcome by downtime	Downtime <30 minutes 41.8% · Downtime >30 minutes 79.3%
PPV for poor outcome among those modeled for exclusion from recruitment	MIRACLE2 ≥5 PPV 0.92 · CULPRIT-SHOCK criteria PPV 0.80 · EUROSHOCK criteria PPV 0.74 · ECLS-SHOCK criteria PPV 0.81

PPV for poor outcome among those modeled for exclusion from recruitment: P < 0.001

Original publication

MIRACLE2 Score Compared With Downtime and Current Selection Criterion for Invasive Cardiovascular Therapies After OHCA. JACC Cardiovasc Interv. Published 21 August 2023. doi:10.1016/j.jcin.2023.08.010

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