MIRACLE2 Score and SCAI Grade to Identify Patients With Out-of-Hospital Cardiac Arrest for Immediate Coronary Angiography

Nilesh Pareek; Nicholas Beckley-Hoelscher; Ritesh Kanyal; Antonio Cannata; Peter Kordis; Nicholas Sunderland; Ali Kirresh; Joanne Nevett; Rachael Fothergill; Ian Webb; Rafal Dworakowski; Narbeh Melikian; Sundeep Kalra; Thomas W Johnson; Gianfranco Sinagra; Serena Rakar; Marko Noc; Ajay M Shah; Jonathan Byrne; Philip MacCarthy

doi:10.1016/j.jcin.2022.03.035

MIRACLE2 Score and SCAI Grade to Identify Patients With Out-of-Hospital Cardiac Arrest for Immediate Coronary Angiography

Nilesh Pareek, Nicholas Beckley-Hoelscher, Ritesh Kanyal, Antonio Cannata, Peter Kordis, Nicholas Sunderland, Ali Kirresh, Joanne Nevett, Rachael Fothergill, Ian Webb, Rafal Dworakowski, Narbeh Melikian, Sundeep Kalra, Thomas W Johnson, Gianfranco Sinagra, Serena Rakar, Marko Noc, Ajay M Shah, Jonathan Byrne, Philip MacCarthy

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

27 Citations (Scopus)

Abstract

OBJECTIVES: The purpose of this study was to evaluate the impact of performing immediate coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) with stratification of predicted neurologic injury and cardiogenic shock on arrival to a center.

BACKGROUND: The role of immediate CAG for patients with OHCA is unclear, which may in part be explained by the majority of patients dying of hypoxic brain injury.

METHODS: Between May 2012 and July 2020, patients from 5 European centers were included in the EUCAR (European Cardiac Arrest Registry). Patients were retrospectively classified into low vs high neurologic risk (MIRACLE2 score 0-3 vs ≥4) and degree of cardiogenic shock on arrival (Society for Cardiovascular Angiography and Interventions [SCAI] grade A vs B-E). A multivariable logistic regression analysis including immediate CAG was performed for the primary outcome of survival with good neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge.

RESULTS: Nine hundred twenty-six patients were included in the registry, with 405 (43.7%) in the low-risk group and 521 (56.3%) in the high-risk group. Immediate CAG was independently associated with improved survival with good neurologic outcome in the low MIRACLE2 risk group with ST-segment elevation myocardial infarction (OR: 11.80; 95% CI: 2.24-76.74; P = 0.048) and with SCAI grade B to E shock (OR: 3.23; 95% CI: 1.10-9.50; P = 0.031). No subgroups, including those with ST-segment elevation myocardial infarction and with SCAI grade B to E shock, achieved any benefit from early CAG in the high MIRACLE2 group.

CONCLUSIONS: Combined classification of patients with OHCA with 12-lead electrocardiography, MIRACLE2 score 0 to 3, and SCAI grade B to E identifies a potential cohort of patients at low risk for neurologic injury who benefit most from immediate CAG.

Original language	English
Pages (from-to)	1074-1084
Number of pages	11
Journal	JACC: Cardiovascular Interventions
Volume	15
Issue number	10
Early online date	16 May 2022
DOIs	https://doi.org/10.1016/j.jcin.2022.03.035
Publication status	Published - 23 May 2022

Bibliographical note

Funding Information:
This work was partly funded by a King’s College Hospital R&D Grant and was supported by the Department of Health through a National Institute for Health Research Biomedical Research Centre award to Guy’s & St. Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. Dr Shah is supported by the British Heart Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2022

Keywords

Cardiopulmonary Resuscitation
Coronary Angiography
Humans
Out-of-Hospital Cardiac Arrest/diagnostic imaging
Percutaneous Coronary Intervention
Retrospective Studies
ST Elevation Myocardial Infarction
Shock, Cardiogenic
Treatment Outcome

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Pareek, N., Beckley-Hoelscher, N., Kanyal, R., Cannata, A., Kordis, P., Sunderland, N., Kirresh, A., Nevett, J., Fothergill, R., Webb, I., Dworakowski, R., Melikian, N., Kalra, S., Johnson, T. W., Sinagra, G., Rakar, S., Noc, M., Shah, A. M., Byrne, J., & MacCarthy, P. (2022). MIRACLE2 Score and SCAI Grade to Identify Patients With Out-of-Hospital Cardiac Arrest for Immediate Coronary Angiography. JACC: Cardiovascular Interventions, 15(10), 1074-1084. https://doi.org/10.1016/j.jcin.2022.03.035

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title = "MIRACLE2 Score and SCAI Grade to Identify Patients With Out-of-Hospital Cardiac Arrest for Immediate Coronary Angiography",

abstract = "OBJECTIVES: The purpose of this study was to evaluate the impact of performing immediate coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) with stratification of predicted neurologic injury and cardiogenic shock on arrival to a center.BACKGROUND: The role of immediate CAG for patients with OHCA is unclear, which may in part be explained by the majority of patients dying of hypoxic brain injury.METHODS: Between May 2012 and July 2020, patients from 5 European centers were included in the EUCAR (European Cardiac Arrest Registry). Patients were retrospectively classified into low vs high neurologic risk (MIRACLE2 score 0-3 vs ≥4) and degree of cardiogenic shock on arrival (Society for Cardiovascular Angiography and Interventions [SCAI] grade A vs B-E). A multivariable logistic regression analysis including immediate CAG was performed for the primary outcome of survival with good neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge.RESULTS: Nine hundred twenty-six patients were included in the registry, with 405 (43.7%) in the low-risk group and 521 (56.3%) in the high-risk group. Immediate CAG was independently associated with improved survival with good neurologic outcome in the low MIRACLE2 risk group with ST-segment elevation myocardial infarction (OR: 11.80; 95% CI: 2.24-76.74; P = 0.048) and with SCAI grade B to E shock (OR: 3.23; 95% CI: 1.10-9.50; P = 0.031). No subgroups, including those with ST-segment elevation myocardial infarction and with SCAI grade B to E shock, achieved any benefit from early CAG in the high MIRACLE2 group.CONCLUSIONS: Combined classification of patients with OHCA with 12-lead electrocardiography, MIRACLE2 score 0 to 3, and SCAI grade B to E identifies a potential cohort of patients at low risk for neurologic injury who benefit most from immediate CAG.",

keywords = "Cardiopulmonary Resuscitation, Coronary Angiography, Humans, Out-of-Hospital Cardiac Arrest/diagnostic imaging, Percutaneous Coronary Intervention, Retrospective Studies, ST Elevation Myocardial Infarction, Shock, Cardiogenic, Treatment Outcome",

author = "Nilesh Pareek and Nicholas Beckley-Hoelscher and Ritesh Kanyal and Antonio Cannata and Peter Kordis and Nicholas Sunderland and Ali Kirresh and Joanne Nevett and Rachael Fothergill and Ian Webb and Rafal Dworakowski and Narbeh Melikian and Sundeep Kalra and Johnson, {Thomas W} and Gianfranco Sinagra and Serena Rakar and Marko Noc and Shah, {Ajay M} and Jonathan Byrne and Philip MacCarthy",

note = "Funding Information: This work was partly funded by a King{\textquoteright}s College Hospital R&D Grant and was supported by the Department of Health through a National Institute for Health Research Biomedical Research Centre award to Guy{\textquoteright}s & St. Thomas{\textquoteright} NHS Foundation Trust in partnership with King{\textquoteright}s College London and King{\textquoteright}s College Hospital NHS Foundation Trust. Dr Shah is supported by the British Heart Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2022",

year = "2022",

month = may,

day = "23",

doi = "10.1016/j.jcin.2022.03.035",

language = "English",

volume = "15",

pages = "1074--1084",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "10",

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Pareek, N, Beckley-Hoelscher, N, Kanyal, R, Cannata, A, Kordis, P, Sunderland, N, Kirresh, A, Nevett, J, Fothergill, R, Webb, I, Dworakowski, R, Melikian, N, Kalra, S, Johnson, TW, Sinagra, G, Rakar, S, Noc, M, Shah, AM, Byrne, J & MacCarthy, P 2022, 'MIRACLE2 Score and SCAI Grade to Identify Patients With Out-of-Hospital Cardiac Arrest for Immediate Coronary Angiography', JACC: Cardiovascular Interventions, vol. 15, no. 10, pp. 1074-1084. https://doi.org/10.1016/j.jcin.2022.03.035

TY - JOUR

T1 - MIRACLE2 Score and SCAI Grade to Identify Patients With Out-of-Hospital Cardiac Arrest for Immediate Coronary Angiography

AU - Pareek, Nilesh

AU - Beckley-Hoelscher, Nicholas

AU - Kanyal, Ritesh

AU - Cannata, Antonio

AU - Kordis, Peter

AU - Sunderland, Nicholas

AU - Kirresh, Ali

AU - Nevett, Joanne

AU - Fothergill, Rachael

AU - Webb, Ian

AU - Dworakowski, Rafal

AU - Melikian, Narbeh

AU - Kalra, Sundeep

AU - Johnson, Thomas W

AU - Sinagra, Gianfranco

AU - Rakar, Serena

AU - Noc, Marko

AU - Shah, Ajay M

AU - Byrne, Jonathan

AU - MacCarthy, Philip

N1 - Funding Information: This work was partly funded by a King’s College Hospital R&D Grant and was supported by the Department of Health through a National Institute for Health Research Biomedical Research Centre award to Guy’s & St. Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. Dr Shah is supported by the British Heart Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022

PY - 2022/5/23

Y1 - 2022/5/23

N2 - OBJECTIVES: The purpose of this study was to evaluate the impact of performing immediate coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) with stratification of predicted neurologic injury and cardiogenic shock on arrival to a center.BACKGROUND: The role of immediate CAG for patients with OHCA is unclear, which may in part be explained by the majority of patients dying of hypoxic brain injury.METHODS: Between May 2012 and July 2020, patients from 5 European centers were included in the EUCAR (European Cardiac Arrest Registry). Patients were retrospectively classified into low vs high neurologic risk (MIRACLE2 score 0-3 vs ≥4) and degree of cardiogenic shock on arrival (Society for Cardiovascular Angiography and Interventions [SCAI] grade A vs B-E). A multivariable logistic regression analysis including immediate CAG was performed for the primary outcome of survival with good neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge.RESULTS: Nine hundred twenty-six patients were included in the registry, with 405 (43.7%) in the low-risk group and 521 (56.3%) in the high-risk group. Immediate CAG was independently associated with improved survival with good neurologic outcome in the low MIRACLE2 risk group with ST-segment elevation myocardial infarction (OR: 11.80; 95% CI: 2.24-76.74; P = 0.048) and with SCAI grade B to E shock (OR: 3.23; 95% CI: 1.10-9.50; P = 0.031). No subgroups, including those with ST-segment elevation myocardial infarction and with SCAI grade B to E shock, achieved any benefit from early CAG in the high MIRACLE2 group.CONCLUSIONS: Combined classification of patients with OHCA with 12-lead electrocardiography, MIRACLE2 score 0 to 3, and SCAI grade B to E identifies a potential cohort of patients at low risk for neurologic injury who benefit most from immediate CAG.

AB - OBJECTIVES: The purpose of this study was to evaluate the impact of performing immediate coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) with stratification of predicted neurologic injury and cardiogenic shock on arrival to a center.BACKGROUND: The role of immediate CAG for patients with OHCA is unclear, which may in part be explained by the majority of patients dying of hypoxic brain injury.METHODS: Between May 2012 and July 2020, patients from 5 European centers were included in the EUCAR (European Cardiac Arrest Registry). Patients were retrospectively classified into low vs high neurologic risk (MIRACLE2 score 0-3 vs ≥4) and degree of cardiogenic shock on arrival (Society for Cardiovascular Angiography and Interventions [SCAI] grade A vs B-E). A multivariable logistic regression analysis including immediate CAG was performed for the primary outcome of survival with good neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge.RESULTS: Nine hundred twenty-six patients were included in the registry, with 405 (43.7%) in the low-risk group and 521 (56.3%) in the high-risk group. Immediate CAG was independently associated with improved survival with good neurologic outcome in the low MIRACLE2 risk group with ST-segment elevation myocardial infarction (OR: 11.80; 95% CI: 2.24-76.74; P = 0.048) and with SCAI grade B to E shock (OR: 3.23; 95% CI: 1.10-9.50; P = 0.031). No subgroups, including those with ST-segment elevation myocardial infarction and with SCAI grade B to E shock, achieved any benefit from early CAG in the high MIRACLE2 group.CONCLUSIONS: Combined classification of patients with OHCA with 12-lead electrocardiography, MIRACLE2 score 0 to 3, and SCAI grade B to E identifies a potential cohort of patients at low risk for neurologic injury who benefit most from immediate CAG.

KW - Cardiopulmonary Resuscitation

KW - Coronary Angiography

KW - Humans

KW - Out-of-Hospital Cardiac Arrest/diagnostic imaging

KW - Percutaneous Coronary Intervention

KW - Retrospective Studies

KW - ST Elevation Myocardial Infarction

KW - Shock, Cardiogenic

KW - Treatment Outcome

U2 - 10.1016/j.jcin.2022.03.035

DO - 10.1016/j.jcin.2022.03.035

M3 - Article (Academic Journal)

C2 - 35589238

SN - 1936-8798

VL - 15

SP - 1074

EP - 1084

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 10

ER -