Key result
Higher CAHP score is linked to ~3.8-fold higher odds of in-hospital mortality.
Why the study?
The performance of the MIRACLE2 and Cardiac Arrest Hospital Prognosis (CAHP) scores for predicting in-hospital mortality in patients with OHCA-STEMI remains unclear.
Do the MIRACLE2 and CAHP scores accurately predict in-hospital mortality in patients with out-of-hospital cardiac arrest and ST-segment elevation myocardial infarction?
Cohort (n=120)
No
Do the MIRACLE2 and CAHP scores accurately predict in-hospital mortality in patients with out-of-hospital cardiac arrest and ST-segment elevation myocardial infarction?
The combination of MIRACLE2 and CAHP risk scores provides highly accurate early in-hospital mortality prediction in patients with OHCA-STEMI, potentially optimizing patient selection for emergent percutaneous coronary intervention.
May aid mortality prediction in OHCA-STEMI; leaves open whether scores should guide PCI selection.
BACKGROUND: Out-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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Burns et al. (2025) conducted a cohort in Out-of-hospital cardiac arrest (OHCA) with ST-segment elevation myocardial infarction (STEMI) (n=120). MIRACLE2 and CAHP risk scores was evaluated on In-hospital mortality (OR 3.84, 95% CI 1.53-9.68, p=0.004). The CAHP score was an independent predictor of in-hospital mortality (OR 3.84), and combined use with the MIRACLE2 score identified patients with >90% mortality, indicating they are unlikely to benefit from percutaneous coronary intervention.
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