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. 2022 May 23;15(10):1074-1084.
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  1 , Nicholas Beckley-Hoelscher  2 , Ritesh Kanyal  3 , Antonio Cannata  3 , Peter Kordis  4 , Nicholas Sunderland  5 , Ali Kirresh  6 , Joanne Nevett  7 , Rachael Fothergill  7 , Ian Webb  3 , Rafal Dworakowski  3 , Narbeh Melikian  3 , Sundeep Kalra  4 , Thomas W Johnson  5 , Gianfranco Sinagra  8 , Serena Rakar  8 , Marko Noc  4 , Ajay M Shah  3 , Jonathan Byrne  3 , Philip MacCarthy  3
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Free article

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

Nilesh Pareek et al. JACC Cardiovasc Interv. .
Free article

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: cardiac arrest; coronary angiography; prediction.

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Conflict of interest statement

Funding Support and Author Disclosures 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.

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