M Abd Razak, George Vamvakas, Michael McGarvey, Samuel McGrath, K S Rathod, Ahmed Elamin, Zhihong Yao, Peter Kordis, Rupert Simpson, Uzma Sajjad, Zaid Iskandar, Mandy Fish, Garry Hamilton, Piotr Pałczyński, Szymon Tuchacz, Arka Das, Salaheldin Agamy, Sundeep Kalra, Abdul Mozid, Rafał Dworakowski, Mariusz Sieminksi, Julian Yeoh, Satpal Arri, Thomas W. Johnson, Nick Curzen, M. Noč, Clare Appleby, Paul Rees, Thomas R. Keeble, Ajay M. Shah, Philip MacCarthy, Jonathan Byrne, Daniel Stahl, Nilesh Pareek
BACKGROUND: The purpose of this study was to prospectively validate the MIRACLE 2 score in the GLOBAL-MIRACLE registry, a multicenter, international, prospective registry of patients admitted with resuscitated out-of-hospital cardiac arrest of presumed cardiac cause. METHODS: From January 1, 2022 to May 31, 2023, 770 patients were recruited from 11 centers across 5 countries. The primary end point was poor neurological outcome (Cerebral Performance Category 3–5) at hospital discharge. Model discrimination was assessed by the area under the receiver operating characteristic curve. 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. RESULTS: The primary end point occurred in 395 (51.2%) patients. The MIRACLE 2 score had an area under the curve of 0.861 (95% CI, 0.835–0.887). A MIRACLE 2 score ≤2 had a negative predictive value of 87.8%, while a score of ≥7 had a positive predictive value of 98.3%. The MIRACLE 2 score had equal performance to the TTM risk tool ( P =0.12) but better discriminatory performance than other risk tools ( P <0.0001). The MIRACLE 2 score showed good performance in those with ST-segment–elevation myocardial infarction (0.851 [95% CI, 0.816–0.886]) and without ST-segment–elevation myocardial infarction (0.873 [95% CI, 0.834–0.912]) and in those with cardiogenic shock (0.832 [95% CI, 0.789–0.875]) and without cardiogenic shock (0.853 [95% CI, 0.810–0.895]). CONCLUSIONS: 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.