Prospective Validation of the MIRACLE2 Score for Early Neurological Stratification After Out-of-Hospital Cardiac-Arrest: The GLOBAL-MIRACLE Registry.

Abd Razak, M.; Vamvakas, G.; McGarvey, M.; McGrath, S.; Rathod, K.; Elamin, A.; Yao, Z.; Kordis, P.; Simpson, R.; Sajjad, U.; Iskandar, Z.; Fish, M.; Hamilton, G.; Palczynski, P.; Tuchacz, S.; Das, A.; Agamy, S.; Kalra, S.; Mozid, A.; Dworakowski, R.; Sieminksi, M.; Yeoh, J.; Arri, S.; Johnson, TW.; Curzen, N.; Noc, M.; Appleby, C.; Rees, P.; Keeble, TR.; Shah, AM.; MacCarthy, P.; Byrne, J.; Stahl, D.; Pareek, N.

Prospective Validation of the MIRACLE2 Score for Early Neurological Stratification After Out-of-Hospital Cardiac-Arrest: The GLOBAL-MIRACLE Registry.

All Authors

Abd Razak, M.

Vamvakas, G.

McGarvey, M.

McGrath, S.

Rathod, K.

Elamin, A.

Yao, Z.

Kordis, P.

Simpson, R.

Sajjad, U.

Show 10 more

LTHT Author

Das, Arka
Mozid, Abdul

LTHT Department

Cardio-Respiratory
Cardiology

Publication Date

2026

Item Type

Journal Article

Subject

HAEMODYNAMICS , PATIENT DISCHARGE , PROGNOSIS , TEMPERATURE

Abstract

BACKGROUND: The purpose of this study was to prospectively validate the MIRACLE2 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 MIRACLE2 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 MIRACLE2 score had an area under the curve of 0.861 (95% CI, 0.835-0.887). A MIRACLE2 score <=2 had a negative predictive value of 87.8%, while a score of >=7 had a positive predictive value of 98.3%. The MIRACLE2 score had equal performance to the TTM risk tool (P=0.12) but better discriminatory performance than other risk tools (P<0.0001). The MIRACLE2 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 MIRACLE2 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 MIRACLE2 score should be evaluated in future randomized controlled trials.