Acute cardiac care & resuscitation
Prospective Validation of the MIRACLE 2 Score for Early Neurological Stratification After Out-of-Hospital Cardiac-Arrest: The GLOBAL-MIRACLE Registry
Authors' conclusion
The MIRACLE 2 score is a practical risk tool that shows excellent discrimination performance for poor neurological outcome after presumed cardiac cause out-of-hospital cardiac arrest, including based on hemodynamic status and admission 12-lead ECG. Early stratification of out-of-hospital cardiac arrest patients using the MIRACLE 2 score should be evaluated in future randomized controlled trials.
Study context
- Population
- Patients admitted with resuscitated out-of-hospital cardiac arrest of presumed cardiac causerecruited from 11 centers across 5 countries, January 1, 2022 to May 31, 2023
- Participants
- 770 patientsEvents: 395 (51.2%)
- Predictors
- MIRACLE 2 score
- Predicted outcome
- poor neurological outcome (Cerebral Performance Category 3-5) at hospital discharge
Methodological detailsprospective validation, 11 centers across 5 countries
- Prospective validation
- 11 centers across 5 countries
Model performance
As reported in the abstract
AUC
MIRACLE 2 score
0.861(95% CI, 0.835-0.887)
MIRACLE 2 score ≤2 negative predictive value
87.8%
MIRACLE 2 score ≥7 positive predictive value
98.3%
Further findings
| Outcome | P value |
|---|---|
| Discrimination of MIRACLE 2 vs other risk toolsMIRACLE 2 score vs TTM risk tool · equal performance | P = 0.12 |
| Discrimination of MIRACLE 2 vs other risk toolsMIRACLE 2 score vs other risk tools · better discriminatory performance with MIRACLE 2 | P < 0.0001 |
AUC
With ST-segment-elevation myocardial infarction
0.851(95% CI, 0.816-0.886)
Without ST-segment-elevation myocardial infarction
0.873(95% CI, 0.834-0.912)
With cardiogenic shock
0.832(95% CI, 0.789-0.875)
Without cardiogenic shock
0.853(95% CI, 0.810-0.895)
Original publication
Prospective Validation of the MIRACLE 2 Score for Early Neurological Stratification After Out-of-Hospital Cardiac-Arrest: The GLOBAL-MIRACLE Registry. Circ Cardiovasc Interv. Published 12 March 2026. doi:10.
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