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

Area of Science:

• Cardiology
• Emergency Medicine
• Intensive Care Medicine

Background:

• The utility of immediate coronary angiography (CAG) following out-of-hospital cardiac arrest (OHCA) remains uncertain.
• Hypoxic brain injury is a primary cause of mortality in OHCA patients, complicating the assessment of CAG benefits.

Purpose of the Study:

• To assess the impact of immediate CAG in OHCA patients.
• Stratify patients based on predicted neurologic injury and cardiogenic shock severity upon hospital arrival.

Main Methods:

• Retrospective analysis of 926 OHCA patients from the European Cardiac Arrest Registry (May 2012-July 2020).
• Patients were categorized by neurologic risk (MIRACLE2 score) and cardiogenic shock (SCAI grade).
• Multivariable logistic regression analyzed the association between immediate CAG and survival with good neurologic outcome.

Main Results:

• Immediate CAG improved survival with good neurologic outcome in low-risk OHCA patients with ST-elevation myocardial infarction (OR: 11.80) and moderate-to-severe shock (OR: 3.23).
• No significant benefit from immediate CAG was observed in high-risk neurologic injury groups, even with ST-elevation myocardial infarction or shock.

Conclusions:

• A combined classification using 12-lead ECG, MIRACLE2 score (0-3), and SCAI grade (B-E) identifies OHCA patients with low neurologic risk.
• This specific cohort demonstrates the most significant benefit from undergoing immediate CAG.