Immediate Coronary Angiography Does Not Improve Survival Outcomes in Cardiac Arrest

Immediate coronary angiography did not improve 30-day survival versus a deferred strategy in patients without an electrocardiogram (ECG) ST-elevation following out-of-hospital cardiac arrest, according to new data from the DISCO trial.1

These data were presented at the European Society of Cardiology (ESC) Congress 2026 in Munich, Germany, by Sten Rubertsson, MD, PhD, professor at the department of surgical sciences, anesthesiology, and intensive care at Uppsala University in Sweden.1

“I think the findings of our study, these results, will be in support of the current ESC guidelines,” Rubertsson told HCPLive in an exclusive interview. “I think this issue is now officially solved, and that we need to move on to other issues of study to try and improve outcomes in patients with cardiac arrest.”

The Direct or Subacute Coronary Angiography in Out-of-hospital Cardiac Arrest (DISCO) trial was a prospective randomized open-label multicenter study with a registry follow-up including patients with out-of-hospital cardiac arrest without ST-elevation on their first ECG. The primary endpoint was 30-day survival, measured via telephone call or visit at 30 days. Secondary outcomes included survival with good neurological function, survival at discharge from ICU and at 6 months, and cardiac function, among others.2

Patients were eligible for inclusion if they exhibited restoration of spontaneous circulation (ROSC) >20 minutes and were expected to undergo coronary angiography within 120 minutes from inclusion and randomization at hospital. Patients were excluded if they had obvious extracardiac genesis of cardiac arrest or ST-elevation, among other criteria.2

A total of 1006 patients were enrolled and randomly assigned in a 1:1 ratio to either immediate coronary angiography or a deferred strategy, in which angiography was intended to be delayed for ≥72 hours. In cases of electrical or hemodynamic instability, angiography could be performed before 72 hours. In the immediate arm, percutaneous coronary intervention (PCI) was recommended on the presumed culprit lesion, while non-culprit lesions were not to be treated.1

Ultimately, Rubertsson and colleagues saw no difference in the primary endpoint at 30 days (54.6% vs 53.6%; HR, 0.95; 95% CI, 0.74-1.21; P = .67). There was also no difference in survival at 180 days, and the team recorded no substantial differences related to neurological recovery based on the intervention used.1

Rubertsson also discussed his belief regarding the utility of electrocardiography as a determiner for the immediacy of coronary angiography, due to its imperfect specificity in detecting the culprit lesion.

“It’s very difficult to say that you should use echocardiography as a reliable tool to decide, because when you’re right after cardiac arrest and you have to make the decision if you’re going to do an immediate coronary angiography, you have areas that are stunned due to the CPR – that doesn’t mean that they have an infarct in that area,” Rubertsson said. “I think that maybe further development with CT angiography could possibly be a better selection, but I don’t think that the sharpness of the tool is good enough for today.”

Editors’ Note: Rubertsson reports no relevant disclosures.

References

1. European Society of Cardiology. Should patients with an out-of-hospital cardiac arrest and without an ECG ST-elevation receive immediate coronary angiography? August 31, 2026. Accessed September 16, 2026. https://www.escardio.org/news/press/press-releases/should-patients-with-an-out-of-hospital-cardiac-arrest-and-without-an-ecg-st-elevation-receive-immediate-coronary-angiography/

2. Uppsala University. Direct or Subacute Coronary Angiography in Out-of-hospital Cardiac Arrest (DISCO). ClinicalTrials.gov Identifier: NCT02309151. Updated April 8, 2026. Accessed September 16, 2026. https://clinicaltrials.gov/study/NCT02309151