ArticleJACC. Case reports2025
Combined MIRACLE2 and CAHP Scores Enhance Mortality Prediction in Out-of-Hospital Cardiac Arrest With STEMI.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOut-of-hospital cardiac arrest (OHCA) with ST-segment elevation myocardial infarction (STEMI) carries a high mortality risk. The MIRACLE2 and Cardiac Arrest Hospital Prognosis (CAHP) scores show promise for neurological outcome prediction, but their performance for in-hospital mortality in patients with OHCA-STEMI remains unclear. PROJECT RATIONALE: Accurate early mortality prediction could guide decisions regarding percutaneous coronary intervention and resource allocation in high-risk patients with OHCA-STEMI. PROJECT SUMMARY: We analyzed 120 patients with OHCA-STEMI (2019-2023), comparing MIRACLE2 and CAHP for mortality prediction. Both demonstrated excellent discrimination (MIRACLE2 0.855 vs CAHP AUC 0.878, P = 0.360). Missing data impacted performance, with CAHP more vulnerable than MIRACLE2. In combined modeling, CAHP retained independent significance while MIRACLE2 did not. Traditional cutoffs (MIRACLE2 ≥5, CAHP >200) had high specificity but poor sensitivity (<25%). Patients with either or both scores elevated by traditional cutoffs demonstrated >90% mortality. Derived cutoffs (MIRACLE2 ≥4, CAHP ≥158) improved sensitivity (MIRACLE2 75.9%, CAHP 81.0%). TAKE-HOME MESSAGES: MIRACLE2 and CAHP are strong predictors of mortality in OHCA-STEMI, and using both in parallel improves identification of patients unlikely to benefit from percutaneous coronary intervention.
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