Immediate coronary angiography shows no survival benefit after cardiac arrest, trial finds

The DISCO trial, the largest randomized trial of its kind, and a meta-analysis of 2,173 patients presented at the ESC Congress 2026, have demonstrated that immediate coronary angiography does not improve 30-day survival rates or neurological recovery compared to a deferred strategy for out-of-hospital cardiac arrest patients without ST-segment elevation. Led by Professor Sten Rubertsson, the trial supports current guidelines recommending delayed angiography, offering clinical clarity to standardize varying practices.

DISCO trial outcomes

• ▪The DISCO trial found no difference in 30-day survival rates between immediate and deferred coronary angiography in cardiac arrest patients without ST-segment elevation (54.6% vs. 53.6%).
• ▪The DISCO trial showed no significant differences in 180-day survival rates or neurological recovery between immediate and deferred coronary angiography groups.
• ▪The DISCO trial randomized 1,006 adult unconscious patients with witnessed out-of-hospital cardiac arrest across 23 centers in Sweden, Denmark, and the Netherlands.

Immediate coronary angiography

• ▪In the DISCO trial, immediate coronary angiography was defined as performing the procedure within 120 minutes of randomization.
• ▪For patients randomized to immediate coronary angiography in the DISCO trial, percutaneous coronary intervention was recommended only for the presumed culprit lesion.

Deferred angiography strategy

• ▪In the DISCO trial, the deferred strategy intended to delay coronary angiography for at least 72 hours.
• ▪In the DISCO trial's deferred group, coronary angiography could be performed before 72 hours in cases of electrical or hemodynamic instability.

ST-segment elevation absence

• ▪The DISCO trial specifically enrolled adult patients who had no ST-segment elevation on a prehospital or emergency department electrocardiogram.
• ▪Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest, but evidence for using coronary angiography in patients without ST-segment elevation is limited.

Current guideline recommendations

• ▪Professor Sten Rubertsson stated that clinical practice regarding coronary angiography timing varies widely due to a lack of definitive evidence on hard clinical outcomes.
• ▪Current clinical guidelines recommend a deferred rather than an immediate strategy for coronary angiography in cardiac arrest patients without ST-segment elevation.

Meta-analysis findings

• ▪A meta-analysis of five randomized controlled trials involving 2,173 patients found no difference in 30-day survival between immediate and deferred coronary angiography.
• ▪The meta-analysis of five trials, led by researchers from Radboud University Medical Centre, included data from the DISCO trial.

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