Prospective Validation of the MIRACLE 2 Score for Early Neurological Stratification After Out-of-Hospital Cardiac-Arrest: The GLOBAL-MIRACLE Registry

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