Abstract:
AIMS:The purpose of this study was to develop a practical risk score to predict poor neurological outcome after out-of-hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre. METHODS AND RESULTS:From May 2012 to December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King's Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multivariable logistic regression to identify predictors of the primary outcome to derive a risk score. This was externally validated in two independent cohorts comprising 473 patients. The primary endpoint was poor neurological outcome at 6-month follow-up (Cerebral Performance Category 3-5). Seven independent predictors of outcome were identified: missed (unwitnessed) arrest, initial non-shockable rhythm, non-reactivity of pupils, age (60-80 years-1 point; >80 years-3 points), changing intra-arrest rhythms, low pH <7.20, and epinephrine administration (2 points). The MIRACLE2 score had an area under the curve (AUC) of 0.90 in the development and 0.84/0.91 in the validation cohorts. Three risk groups were defined-low risk (MIRACLE2 ≤2-5.6% risk of poor outcome); intermediate risk (MIRACLE2 of 3-4-55.4% of poor outcome); and high risk (MIRACLE2 ≥5-92.3% risk of poor outcome). The MIRACLE2 score had superior discrimination than the OHCA [median AUC 0.83 (0.818-0.840); P < 0.001] and Cardiac Arrest Hospital Prognosis models [median AUC 0.87 (0.860-0.870; P = 0.001] and equivalent performance with the Target Temperature Management score [median AUC 0.88 (0.876-0.887); P = 0.092]. CONCLUSIONS:The MIRACLE2 is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Pareek N,Kordis P,Beckley-Hoelscher N,Pimenta D,Kocjancic ST,Jazbec A,Nevett J,Fothergill R,Kalra S,Lockie T,Shah AM,Byrne J,Noc M,MacCarthy Pdoi
10.1093/eurheartj/ehaa570subject
Has Abstractpub_date
2020-12-14 00:00:00pages
4508-4517issue
47eissn
0195-668Xissn
1522-9645pii
5878044journal_volume
41pub_type
杂志文章abstract:AIMS:The aim of this study was to investigate the 12-month incidence, predictive factors, and prognosis of sustained ventricular tachycardia (VT) in chronic heart failure patients implanted with biventricular pacemakers without a back-up defibrillator (CRT-P), assessed by continuous intracardiac ventricular electrogram...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehp071
更新日期:2009-05-01 00:00:00
abstract::In this study, betathromboglobulin (BTG) and fibrinopeptide A (FPA) in peripheral venous blood were measured in 20 patients with stable angina pectoris before and immediately after exercise-induced myocardial ischaemia; in 5 of the 20 patients stable angina was associated with typical peripheral artery disease. A tota...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/8.7.734
更新日期:1987-07-01 00:00:00
abstract:AIMS:This is a prospective, randomized study comparing transvenous cryoablation with radiofrequency (RF) ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). METHODS AND RESULTS:In this pilot trial, 200 patients with AVNRT were randomized to undergo cryoablation or RF ablation of the slow pathway. A 7 Fr...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.ehj.2004.07.020
更新日期:2004-12-01 00:00:00
abstract::In the present study 27 post-myocardial infarction patients were treated with Persantin capsules (Depot-Kapseln, sustained release form), containing 200 mg dipyridamole, b.i.d. over a period of 3 weeks. Baseline levels for plasma beta-thromboglobulin (BTG), platelet factor 4 (PF4), and serum thromboxane B2 (TXB2) were...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061891
更新日期:1985-06-01 00:00:00
abstract::The diagnosis and management of patients with renovascular disease and hypertension continue to elude healthcare providers. The advent of novel imaging and interventional techniques, and increased understanding of the pathways leading to irreversible renal injury and renovascular hypertension, have ushered in commenda...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/ehq510
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Electrocardiographic abnormalities and premature ventricular contractions are common in athletes and are generally benign. However, the specific outcome of high-level endurance athletes with frequent and complex ventricular arrhythmias is unclear. Also, information on the predictive accuracy of different inv...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/s0195-668x(03)00282-3
更新日期:2003-08-01 00:00:00
abstract::Although the main cardiac complication in patients with rheumatoid arthritis is subclinical pericarditis, mononuclear cell infiltrations into myocardium may cause cardiac arrhythmias and conduction defects. In order to examine these problems we evaluated 70 patients (53 women and 17 men) aged 18-83 years (average 56.7...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061005
更新日期:1995-06-01 00:00:00
abstract::Intracoronary ultrasound was performed at diagnostic coronary angiography and 10 days later in a 45-year-old patient with a 3-day history of acute inferior myocardial infarction. Coronary angiography showed considerable stenosis (80%) in the distal right coronary artery (RCA) (pre the crux) and what appeared to be a d...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061061
更新日期:1995-08-01 00:00:00
abstract::We describe a patient with a large intramyocardial hydatid cyst lying in the postero-lateral segment of the left ventricle near the atrioventricular groove level which ruptured into the pericardial sac, resulting in cardiac tamponade. Cross-sectional echocardiographic examination from a modified four-chamber apical vi...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/9.7.819
更新日期:1988-07-01 00:00:00
abstract::Cardiac hypertrophy was induced in rats either by isoprenaline treatment or by experimental abdominal aortic stenosis. In both models, the UTP content increased in the hypertrophying heart, while the ATP level remained depressed. The rate of net synthesis of uracil nucleotides, estimated by phosphate incorporation int...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/5.suppl_f.155
更新日期:1984-12-01 00:00:00
abstract:AIMS:The risk of gastrointestinal (GI) bleeding limits the use of antiplatelet and anticoagulant drugs. Risk factors for GI bleeding in post- myocardial infarction (MI) patients have not been well defined. We sought to identify risk factors for GI bleeding in patients following MI. METHODS AND RESULTS:The VALsartan In...
journal_title:European heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1093/eurheartj/ehp256
更新日期:2009-09-01 00:00:00
abstract:AIMS:Growth-differentiation factor-15 (GDF-15) has emerged as a biomarker of increased mortality and recurrent myocardial infarction (MI) in patients diagnosed with non-ST-elevation acute coronary syndrome. We explored the usefulness of GDF-15 for early risk stratification in 479 unselected patients with acute chest pa...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehn339
更新日期:2008-10-01 00:00:00
abstract:AIMS:Because benefits of cardiac resynchronization therapy (CRT) appear to be less favourable in non-left bundle branch block (LBBB) patients, this prospective longitudinal study tested the hypothesis that QRS morphology and echocardiographic mechanical dyssynchrony were associated with long-term outcome after CRT. ME...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehs013
更新日期:2012-11-01 00:00:00
abstract:AIMS:The increasing number of adults with congenital heart disease (CHD) has prompted the development of recommendations for the management of these patients and for the organization of their healthcare. The aim of this report is to describe the delivery of care in Europe for adults with congenital cardiac anomalies. ...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehi858
更新日期:2006-06-01 00:00:00
abstract::Stephan Achenbach reviews the history of coronary computer tomography angiography and discusses its further evolution. ...
journal_title:European heart journal
pub_type: 杂志文章
doi:
更新日期:2016-02-21 00:00:00
abstract:AIMS:We examined the left lateral ridge (LLR) between the orifices of the left pulmonary veins and the left atrial appendage for a better understanding of its structural composition relevant to ablations for atrial fibrillation (AF). METHODS AND RESULTS:The LLR and its surrounding areas were studied in 40 heart specim...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehm606
更新日期:2008-02-01 00:00:00
abstract::Strong experimental evidence links ventricular fibrillation to an increased temporal dispersion of the recovery of excitability. The effect of an overall prolongation of repolarization and an increased basic dispersion of repolarization on premature dispersion was studied on ventricular surface in 10 dogs. Our observa...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/6.suppl_d.15
更新日期:1985-11-01 00:00:00
abstract::In the initial phase of heart failure, cardiac output and pressure are maintained by increasing sympathetic drive and by cell hypertrophy. Elevated end-diastolic volume, a reduced ejection fraction and a higher filling pressure also occur. Only in more severe heart failure, when cardiac output cannot be maintained, do...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/16.suppl_f.2
更新日期:1995-07-01 00:00:00
abstract:AIMS:To evaluate efficacy and safety of intrapericardial treatment with the crystalloid corticosteroid triamcinolone in autoreactive pericardial effusion. METHODS AND RESULTS:Two hundred and sixty consecutive patients with pericarditis/myopericarditis underwent pericardiocentesis, pericardioscopy (Storz-AF1101B1), and...
journal_title:European heart journal
pub_type: 临床试验,杂志文章
doi:10.1053/euhj.2002.3152
更新日期:2002-10-01 00:00:00
abstract:AIMS:It has been proposed that competitive sport increases the risk of ventricular tachyarrhythmias (VTA) and death in patients with arrhythmogenic right-ventricular cardiomyopathy (ARVC). However, it is unknown whether this only applies to competitive sport or if recreational sports activity also increases the risk of...
journal_title:European heart journal
pub_type: 临床试验,杂志文章
doi:10.1093/eurheartj/ehv110
更新日期:2015-07-14 00:00:00
abstract::To evaluate the efficacy and safety of hirudin, a direct thrombin inhibitor, in patients with acute myocardial infarction, a dose-finding, angiography study was carried out. After a pilot phase in 10 patients treated with a bolus of 0.1 mg.kg-1 and a continuous infusion of 0.06 mg.kg-1.h-1 (dose group I), two doses of...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/16.suppl_d.33
更新日期:1995-07-01 00:00:00
abstract:BACKGROUND:Oral dipyridamole induces accumulation of endogenous adenosine, which in a hypoxic milieu exerts experimentally an angiogenic effect on coronary collateral circulation. A meta-analysis of 13 randomized placebo-controlled trials published between 1960 and 1992 showed evidence of benefit for dipyridamole in th...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1053/euhj.2001.2623
更新日期:2001-10-01 00:00:00
abstract:AIMS:Support with left ventricular assist devices (LVAD) improves cardiac performance in patients with end-stage heart failure. In some cases this strategy, combined with pharmacological treatment, has led to a clinical improvement which remained after LVAD explant. This study defines changes in Ca handling at the cell...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1016/s0195-668x(03)00242-2
更新日期:2003-07-01 00:00:00
abstract::The transdermal nitroglycerin patches have been very successful nitrate formulations since their introduction in 1982. Nevertheless, considerable controversy regarding efficacy and tolerance has arisen. Nitroglycerin has multiple mechanisms of action in angina pectoris. Transdermal nitroglycerin in ointment formulatio...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/10.suppl_a.11
更新日期:1989-05-01 00:00:00
abstract::After single chamber atrial pacemaker implantation, serial electrophysiologic studies were performed noninvasively at intervals of 3 months over a total period of 3 years in 24 patients with symptomatic sinus node dysfunction. All patients underwent invasive electrophysiologic studies before pacemaker implantation and...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061719
更新日期:1984-08-01 00:00:00
abstract::Adolescent CD-1 mice inoculated with coxsackievirus B3 (CVB3m) will develop acute myocarditis with focal lesions by 7 days post-inoculation (p.i.). Administration of murine sera containing anti-CVB3m-neutralizing antibodies into CVB3m-inoculated mice at 3 days p.i. will exacerbate myocarditis, suggesting the presence ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/12.suppl_d.124
更新日期:1991-08-01 00:00:00
abstract:AIMS:To test whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) was independently associated with, and improved the prediction of, cardiovascular disease (CVD) in a primary prevention cohort. METHODS AND RESULTS:In the West of Scotland Coronary Prevention Study (WOSCOPS), a cohort of middle-aged men with hy...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehs239
更新日期:2013-02-01 00:00:00
abstract::Sixty patients (31 male, 29 female) were studied in a 4-week double-blind parallel dose-response study. Patients received amlodipine 1.25 mg (n = 12), 2.5 mg (n = 12), 5 mg (n = 12), 10 mg (n = 12) or placebo (n = 12) once a day. Anti-anginal efficacy was assessed by sequential treadmill testing 24 h post-dose, freque...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/oxfordjournals.eurheartj.a059864
更新日期:1991-02-01 00:00:00
abstract:AIMS:Intense exercise places disproportionate strain on the right ventricle (RV) which may promote pro-arrhythmic remodelling in some athletes. RV exercise imaging may enable early identification of athletes at risk of arrhythmias. METHODS AND RESULTS:Exercise imaging was performed in 17 athletes with RV ventricular a...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehv202
更新日期:2015-08-07 00:00:00
abstract:AIMS:Various definitions of major bleeding have been used to evaluate safety in randomized controlled trials of antiplatelet therapy. We compared the definitions and rates of major bleeding in phase III randomized controlled trials of oral P2Y(12) inhibitors in the management of patients with acute coronary syndromes (...
journal_title:European heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1093/eurheartj/ehr143
更新日期:2011-09-01 00:00:00