Acute cardiac care & resuscitationCohort study
Prospective Validation of the MIRACLE 2 Score for Early Neurological Stratification After Out-of-Hospital Cardiac-Arrest: The GLOBAL-MIRACLE Registry
- multicenter, international, prospective registry
- prospective validation
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
- Participants
- 770 patients
- Exposure
- We compared the discriminatory performance of the MIRACLE 2 score against Cardiac Arrest Hospital Prognosis, out-of-hospital cardiac arrest, Target Temperature Management, NULL-PLEASE, C-GRAPH, and rCAST.
- Outcome
- Poor neurological outcome (Cerebral Performance Category 3-5)
- Follow-up
- Hospital discharge
Main finding
As reported in the abstract
Primary end point occurred
395 (51.2%) patients
MIRACLE 2 score area under the curve
0.861 (95% CI, 0.835-0.887)
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Discriminatory performance vs other risk tools — MIRACLE 2 score vs TTM risk tool · equal performance | P = 0.12 |
| Discriminatory performance vs other risk tools — MIRACLE 2 score vs other risk tools · better discriminatory performance with MIRACLE 2 score | P < 0.0001 |
Predictive values of MIRACLE 2 score thresholds
- MIRACLE 2 score ≤2 negative predictive value
- 87.8%
- MIRACLE 2 score ≥7 positive predictive value
- 98.3%
MIRACLE 2 score performance by subgroup
- 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
Summarised from the published abstract; every number is checked against it