TY - JOUR
T1 - MIRACLE2 Score Compared With Downtime and Current Selection Criterion for Invasive Cardiovascular Therapies After OHCA.
AU - Aldous, Robert
AU - Roy, Roman
AU - Cannata, Antonio
AU - Abdrazak, Muhamad
AU - Mohanan, Shamika
AU - Beckley-Hoelscher, Nicholas
AU - Stahl, Daniel
AU - Kanyal, Ritesh
AU - Kordis, Peter
AU - Sunderland, Nicholas
AU - Parczewska, Aleksandra
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 - Patel, Sameer
AU - Auzinger, Georg
AU - Gruchala, Marcin
AU - Shah, Ajay M
AU - Byrne, Jonathan
AU - MacCarthy, Philip
AU - Pareek, Nilesh
N1 - Copyright © 2023 American College of Cardiology Foundation. All rights reserved.
PY - 2023/10/9
Y1 - 2023/10/9
N2 - BACKGROUND: The MIRACLE
2 score is the only risk score that does not incorporate and can be used for selection of therapies after out-of-hospital cardiac arrest (OHCA).
OBJECTIVES: This study sought to compare the discrimination performance of the MIRACLE
2 score, downtime, and current randomized controlled trial (RCT) recruitment criteria in predicting poor neurologic outcome after out-of-hospital cardiac arrest (OHCA).
METHODS: We used the EUCAR (European Cardiac Arrest Registry), a retrospective cohort from 6 centers (May 2012-September 2022). The primary outcome was poor neurologic outcome on hospital discharge (cerebral performance category 3-5).RESULTS: A total of 1,259 patients (total downtime = 25 minutes; IQR: 15-36 minutes) were included in the study. Poor outcome occurred in 41.8% with downtime <30 minutes and in 79.3% for those with downtime >30 minutes. In a multivariable logistic regression analysis, MIRACLE
2 had a stronger association with outcome (OR: 2.23; 95% CI: 1.98-2.51; P < 0.0001) than zero flow (OR: 1.07; 95% CI: 1.01-1.13; P = 0.013), low flow (OR: 1.04; 95% CI: 0.99-1.09; P = 0.054), and total downtime (OR: 0.99; 95% CI: 0.95-1.03; P = 0.52). MIRACLE
2 had substantially superior discrimination for the primary endpoint (AUC: 0.877; 95% CI: 0.854-0.897) than zero flow (AUC: 0.610; 95% CI: 0.577-0.642), low flow (AUC: 0.725; 95% CI: 0.695-0.754), and total downtime (AUC: 0.732; 95% CI: 0.701-0.760). For those modeled for exclusion from study recruitment, the positive predictive value of MIRACLE
2 ≥5 for poor outcome was significantly higher (0.92) than the CULPRIT-SHOCK (Culprit lesion only PCI Versus Multivessel PCI in Cardiogenic Shock) (0.80), EUROSHOCK (Testing the value of Novel Strategy and Its Cost Efficacy In Order to Improve the Poor Outcomes in Cardiogenic Shock) (0.74) and ECLS-SHOCK (Extra-corporeal life support in Cardiogenic shock) criteria (0.81) (P < 0.001).
CONCLUSIONS: The MIRACLE
2 score has superior prediction of outcome after OHCA than downtime and higher discrimination of poor outcome than the current RCT recruitment criteria. The potential for the MIRACLE
2 score to improve the selection of OHCA patients should be evaluated formally in future RCTs.
AB - BACKGROUND: The MIRACLE
2 score is the only risk score that does not incorporate and can be used for selection of therapies after out-of-hospital cardiac arrest (OHCA).
OBJECTIVES: This study sought to compare the discrimination performance of the MIRACLE
2 score, downtime, and current randomized controlled trial (RCT) recruitment criteria in predicting poor neurologic outcome after out-of-hospital cardiac arrest (OHCA).
METHODS: We used the EUCAR (European Cardiac Arrest Registry), a retrospective cohort from 6 centers (May 2012-September 2022). The primary outcome was poor neurologic outcome on hospital discharge (cerebral performance category 3-5).RESULTS: A total of 1,259 patients (total downtime = 25 minutes; IQR: 15-36 minutes) were included in the study. Poor outcome occurred in 41.8% with downtime <30 minutes and in 79.3% for those with downtime >30 minutes. In a multivariable logistic regression analysis, MIRACLE
2 had a stronger association with outcome (OR: 2.23; 95% CI: 1.98-2.51; P < 0.0001) than zero flow (OR: 1.07; 95% CI: 1.01-1.13; P = 0.013), low flow (OR: 1.04; 95% CI: 0.99-1.09; P = 0.054), and total downtime (OR: 0.99; 95% CI: 0.95-1.03; P = 0.52). MIRACLE
2 had substantially superior discrimination for the primary endpoint (AUC: 0.877; 95% CI: 0.854-0.897) than zero flow (AUC: 0.610; 95% CI: 0.577-0.642), low flow (AUC: 0.725; 95% CI: 0.695-0.754), and total downtime (AUC: 0.732; 95% CI: 0.701-0.760). For those modeled for exclusion from study recruitment, the positive predictive value of MIRACLE
2 ≥5 for poor outcome was significantly higher (0.92) than the CULPRIT-SHOCK (Culprit lesion only PCI Versus Multivessel PCI in Cardiogenic Shock) (0.80), EUROSHOCK (Testing the value of Novel Strategy and Its Cost Efficacy In Order to Improve the Poor Outcomes in Cardiogenic Shock) (0.74) and ECLS-SHOCK (Extra-corporeal life support in Cardiogenic shock) criteria (0.81) (P < 0.001).
CONCLUSIONS: The MIRACLE
2 score has superior prediction of outcome after OHCA than downtime and higher discrimination of poor outcome than the current RCT recruitment criteria. The potential for the MIRACLE
2 score to improve the selection of OHCA patients should be evaluated formally in future RCTs.
KW - Humans
KW - Out-of-Hospital Cardiac Arrest/diagnosis
KW - Cardiopulmonary Resuscitation
KW - Treatment Outcome
KW - Shock, Cardiogenic
KW - Forecasting
U2 - 10.1016/j.jcin.2023.08.010
DO - 10.1016/j.jcin.2023.08.010
M3 - Article (Academic Journal)
C2 - 37609699
SN - 1936-8798
VL - 16
SP - 2439
EP - 2450
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 19
ER -