Key takeaways
- Whether or not quick coronary angiography ought to be carried out routinely in unconscious sufferers with out an ECG ST-elevation after out-of-hospital cardiac arrest is unsure because of the lack of information from giant, randomised trials.
- Outcomes from the DISCO trial demonstrated that quick coronary angiography didn’t enhance 30-day survival in contrast with a deferred technique.
- Related outcomes had been noticed when outcomes from DISCO and 4 smaller trials had been analysed collectively.
- These findings present assist for present guideline suggestions towards routine quick coronary angiography in these sufferers.
Munich, Germany – 31 August 2026: Quick coronary angiography didn’t enhance 30-day survival in contrast with a deferred technique in sufferers with out an ECG ST-elevation after out-of-hospital cardiac arrest. These had been the principle findings of the DISCO trial and a meta-analysis offered in a Scorching Line session right now at ESC Congress 2026.[1,2]
Acute coronary syndrome is a typical reason behind out-of-hospital cardiac arrest (OHCA). In sufferers with OHCA presenting with an ST-elevation on an ECG, quick coronary angiography to evaluate artery blockages is really helpful, with subsequent percutaneous coronary intervention (PCI) the place essential to revive blood move. Nonetheless, proof for using coronary angiography in sufferers with out an ECG ST-elevation is proscribed.
Lead Investigator of the DISCO trial, Professor Sten Rubertsson from Uppsala College, Sweden, commented, “Present tips suggest a deferred relatively than an instantaneous technique for coronary angiography, based mostly primarily on the impartial outcomes from two medium-sized trials. Nonetheless, medical follow varies extensively and this can be because of the lack of definitive proof on onerous medical outcomes. The intention of the big DISCO trial was to find out whether or not quick coronary angiography does or doesn’t enhance survival in sufferers after an OHCA with out an ST-elevation.”
The trial was carried out in 23 centres in Sweden, Denmark and the Netherlands. Grownup unconscious sufferers with witnessed OHCA, return of spontaneous circulation and with out ST-elevation on prehospital or emergency division ECG had been included. Sufferers had been randomised (1:1) to quick coronary angiography (inside 120 minutes) or to a deferred technique during which coronary angiography was meant to be delayed for a minimum of 72 hours. In circumstances {of electrical} or haemodynamic instability, coronary angiography may very well be carried out earlier than 72 hours. Within the quick group, PCI was really helpful on the presumed perpetrator lesion, whereas non-culprit lesions had been to not be handled in the course of the acute process. A complete of 1,006 sufferers had been included who had a imply age of 67 years and round one-quarter had been ladies.
No distinction within the major endpoint of survival at 30 days was noticed between quick and deferred coronary angiography (54.6% vs. 53.6%; hazard ratio [HR] 0.95; 95% confidence interval [CI] 0.74 to 1.21; p=0.67). Equally, there was no distinction between the teams for survival at 180 days. There have been additionally no vital variations in secondary endpoints associated to neurological restoration.
“With these outcomes from the biggest randomised trial investigating this medical dilemma, we will now conclusively say that quick coronary angiography after OHCA doesn’t enhance outcomes over a deferred technique,” acknowledged Professor Rubertsson.
Researchers from Radboud College Medical Centre, Nijmegen, the Netherlands, led by Professor Niels van Royen, carried out a person affected person information meta-analysis of 5 randomised managed trials, which included DISCO and concerned information from 2,173 sufferers.2 As offered by Ms Lente Pol, there was no distinction in 30-day survival between sufferers who acquired quick coronary angiography and those that didn’t. “These outcomes present that we will safely delay coronary angiography in sufferers after OHCA with out ST elevation,” she concluded.
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