Acute cardiac care & resuscitationCohort study
MIRACLE2 Score Compared With Downtime and Current Selection Criterion for Invasive Cardiovascular Therapies After OHCA
- Retrospective cohort study
- multicentre (6 centres)
- registry-based
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
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) |
Observational data: associations, not effects.
Further findings
Association with poor outcome (multivariable logistic regression)
| Comparison | OR (95% CI) | P value | |
|---|---|---|---|
| MIRACLE2 | 2.23 (1.98–2.51) | P < 0.0001 | |
| Zero flow | 1.07 (1.01–1.13) | P = 0.013 | |
| Low flow | 1.04 (0.99–1.09) | P = 0.054 | |
| Total downtime | 0.99 (0.95–1.03) | P = 0.52 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Values | Estimate | P value |
|---|---|---|---|
| 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
Summarised from the published abstract; every number is checked against it