Rapid 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 have been the principle findings of the DISCO trial and a meta-analysis offered in a Sizzling Line session at present at ESC Congress 2026.
Acute coronary syndrome is a standard reason for out-of-hospital cardiac arrest (OHCA). In sufferers with OHCA presenting with an ST-elevation on an ECG, speedy coronary angiography to evaluate artery blockages is advisable, with subsequent percutaneous coronary intervention (PCI) the place essential to revive blood circulate. Nonetheless, proof for the usage of coronary angiography in sufferers with out an ECG ST-elevation is restricted.
Present pointers advocate a deferred relatively than a right away technique for coronary angiography, primarily based primarily on the impartial outcomes from two medium-sized trials. Nonetheless, scientific follow varies extensively and this can be because of the lack of definitive proof on onerous scientific outcomes. The goal of the big DISCO trial was to find out whether or not speedy coronary angiography does or doesn’t enhance survival in sufferers after an OHCA with out an ST-elevation.”
Professor Sten Rubertsson, Lead Investigator of the DISCO trial, Uppsala College, Sweden
The trial was carried out in 23 facilities 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 have been included. Sufferers have been randomized (1:1) to speedy coronary angiography (inside 120 minutes) or to a deferred technique wherein coronary angiography was supposed to be delayed for at the least 72 hours. In instances {of electrical} or haemodynamic instability, coronary angiography could possibly be carried out earlier than 72 hours. Within the speedy group, PCI was advisable on the presumed perpetrator lesion, whereas non-culprit lesions have been to not be handled through the acute process. A complete of 1,006 sufferers have been included who had a imply age of 67 years and round one-quarter have been ladies.
No distinction within the main endpoint of survival at 30 days was noticed between speedy 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 randomized trial investigating this scientific dilemma, we will now conclusively say that speedy coronary angiography after OHCA doesn’t enhance outcomes over a deferred technique,” acknowledged Professor Rubertsson.
Researchers from Radboud College Medical Heart, Nijmegen, the Netherlands, led by Professor Niels van Royen, carried out a person affected person knowledge meta-analysis of 5 randomized managed trials, which included DISCO and concerned knowledge from 2,173 sufferers. As offered by Ms Lente Pol, there was no distinction in 30-day survival between sufferers who acquired speedy coronary angiography and people who 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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