DISCOAcute Cardiac CareOpen Access
Immediate Versus Deferred Coronary Angiography After Cardiac Arrest Without ST-Elevation
Acute coronary angiography after resuscitated out-of-hospital cardiac arrest without ST-elevation on the electrocardiogram
Why the trial?
After resuscitated out-of-hospital cardiac arrest without ST-elevation, the value of taking patients immediately to coronary angiography remained uncertain. DISCO tested acute coronary angiography against standard care in this population.
Does immediate coronary angiography improve 30-day survival in unconscious adults with witnessed out-of-hospital cardiac arrest, return of spontaneous circulation, and no ST-elevation compared to a deferred strategy?
Population
1,006 unconscious adults with OHCA and no ST-elevation; mean age 67, ~25% women
Comparison
Immediate angiography (<120 min) vs deferred (>=72 h unless unstable)
Design
Multicenter randomized trial (23 centres: Sweden, Denmark, Netherlands)
Follow-up
30 days (primary); 180 days for secondary endpoints
Key result
Immediate coronary angiography did not improve 30-day survival compared to a deferred strategy in resuscitated out-of-hospital cardiac arrest without ST-elevation (HR 0.95; 95% CI 0.74-1.21; p=0.67).
Authors
Discussion
Member takes
Where experts stand
Experts read DISCO as confirming that rushing unconscious cardiac arrest patients without ST-elevation to the cath lab does not improve survival, reinforcing a deferred angiography approach.
DISCO found no survival benefit from immediate coronary angiography in unconscious out-of-hospital cardiac arrest patients without ST-elevation, and early expert commentary treats the result as consistent with prior evidence. One interventional cardiologist highlights a patient-level meta-analysis pointing in the same direction. The live question is whether guidelines will now formally endorse a deferred-first strategy in this population.
Still unclear
It remains unclear whether these results will prompt formal guideline changes favoring a deferred angiography strategy for OHCA patients without ST-elevation. Whether specific subgroups might still benefit from immediate angiography has not been addressed in the expert commentary so far.
Key expert perspectives
C. Michael GibsonInterventional / Structural Cardiology · Beth Israel Deaconess Medical CenterContextAug 31An individual patient data meta-analysis of over 2,000 patients confirms no survival difference
Gibson highlights that beyond DISCO itself, an individual patient data meta-analysis of more than 2,000 comatose out-of-hospital cardiac arrest patients without ST-segment elevation found no difference in 30-day survival between immediate and deferred coronary angiography. He frames DISCO as consistent with that broader evidence base, showing no benefit at 30 or 180 days.
Overview
Favors deferred angiography in resuscitated OHCA without ST-elevation; challenges routine immediate catheterization in guidelines.
Key Points
- To determine whether immediate coronary angiography improves survival compared with a deferred invasive strategy in resuscitated out-of-hospital cardiac arrest patients without ST-elevation.
- Multicenter randomized trial (DISCO) across 23 centres in Sweden, Denmark, and the Netherlands enrolling 1,006 unconscious adults with witnessed out-of-hospital cardiac arrest and return of spontaneous circulation without ST-elevation.
- Participants were randomly assigned to immediate coronary angiography within 120 minutes or a deferred strategy delaying angiography by at least 72 hours unless clinical instability occurred.
- 30-day survival was 54.6% with immediate angiography compared to 53.6% with deferred angiography (HR 0.95, 95% CI 0.74 to 1.21; p=0.67).
- No significant differences occurred between groups for 180-day survival or neurological-recovery endpoints.
Evidence details
What drove the result?
| Outcome | Immediate | Deferred |
|---|---|---|
| 30-day survival | 54.6% | 53.6% |
| Primary endpoint · HR 0.95 (95% CI 0.74-1.21); p=0.67 | ||
Limitations & tradeoffs
Statistical certainty
The CI (0.74–1.21) is compatible with modest benefit or harm, and per-arm event counts and numeric 180-day survival and neurological-recovery results are not reported.
Design limitations
The deferred strategy permitted early angiography for electrical or haemodynamic instability, which can dilute between-group separation, and no safety or procedural complication data are reported.
Structured PICO
Does immediate coronary angiography improve 30-day survival in unconscious adults with witnessed out-of-hospital cardiac arrest, return of spontaneous circulation, and no ST-elevation compared to a deferred strategy?
P
Population
1,006 unconscious adults with witnessed out-of-hospital cardiac arrest, return of spontaneous circulation, and no ST-elevation, followed for up to 180 days.
I
Intervention
Immediate coronary angiography (within 120 minutes)
C
Comparator
Deferred strategy intended to delay angiography at least 72 hours unless electrical or haemodynamic instability occurred
O
Outcome
30-day survivalhard clinical
Immediate coronary angiography does not improve 30-day survival compared to a deferred strategy in unconscious patients with out-of-hospital cardiac arrest and no ST-elevation.
Main Result
Hazard Ratio: 0.95 (95% CI 0.74–1.21)
Absolute Event Rate: 54.6% vs 53.6%
p-value: p=0.67
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Sten Rubertsson (2026) conducted an RCT in Out-of-hospital cardiac arrest without ST-elevation (n=1,006). Immediate coronary angiography vs. Deferred coronary angiography was evaluated on 30-day survival (HR 0.95, 95% CI 0.74 to 1.21, p=0.67). Immediate coronary angiography did not improve 30-day survival compared to a deferred strategy in resuscitated out-of-hospital cardiac arrest without ST-elevation (HR 0.95; 95% CI 0.74-1.21; p=0.67).