Immediate coronary angiography does not improve 30-day survival compared with a deferred strategy in patients without an ECG ST-elevation after out-of-hospital cardiac arrest, according to findings from the DISCO trial and an individual patient data meta-analysis presented at the ESC Congress 2026. Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest, but while immediate coronary angiography to assess artery blockages is recommended for patients with ST-elevation, evidence for those without it is limited.
DISCO Trial Results Challenge Immediate Angiography Strategy
The DISCO trial, headed by Professor Sten Rubertsson of Uppsala University in Sweden, investigated whether performing immediate coronary angiography enhances survival rates among patients who have experienced an OHCA without an ST-elevation. Adults who were unconscious following a witnessed OHCA, achieved a return of spontaneous circulation, and lacked ST-elevation on prehospital or emergency department ECGs met the inclusion criteria. Researchers randomized 1,006 patients across 23 centers in Sweden, Denmark and the Netherlands into two distinct treatment tracks.
Patients in the immediate group were randomized to immediate coronary angiography (within 120 minutes). Those in the deferred group were randomized to a deferred strategy in which coronary angiography was intended to be delayed for at least 72 hours, unless electrical or haemodynamic instability forced an earlier intervention. Results showed no difference in the primary endpoint of survival at 30 days, which stood at 54.6% for the immediate group versus 53.6% for the deferred group, yielding a hazard ratio [HR] of 0.95 (95% confidence interval [CI] 0.74 to 1.21; p=0.67), according to trial data.
Did you know? Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest (OHCA).
Meta-Analysis Confirms Safety of Delaying Procedures
An individual patient data meta-analysis encompassing five randomized controlled trials—including DISCO and pooling information from 2,173 patients—was undertaken by investigators at Radboud University Medical Center in Nijmegen, the Netherlands, under the direction of Professor Niels van Royen. Presented by Ms Lente Pol at the ESC Congress 2026, the analysis reinforced the primary findings ofetr the DISCO trial.
Analysis of the combined dataset revealed a lack of disparity in 30-day survival rates comparing individuals who underwent prompt coronary angiography against those who did not. “These results show that we can safely delay coronary angiography in patients after OHCA without ST elevation,” Ms Lente Pol concluded regarding the meta-analysis findings.
Clinical Practice and Future Guidelines
Rather than an immediate approach, current medical guidelines advise utilizing a deferred strategy for coronary angiography, a recommendation primarily driven by neutral outcomes from a pair of medium-scale trials. Nonetheless, clinical practice varies widely and this may be due to the lack of definitive evidence on hard clinical outcomes. With the publication of the DISCO trial—described by Professor Rubertsson as the largest randomized trial investigating this clinical dilemma—clinicians now have robust data confirming that immediate coronary angiography after OHCA does not improve outcomes over a deferred strategy.
Pro Tip: Healthcare providers reviewing post-resuscitation care protocols can reference the DISCO trial and the individual patient data meta-analysis presented at ESC Congress 2026 to support deferred angiography pathways in non-ST-elevation cohorts.
Frequently Asked Questions
What was the main finding of the DISCO trial?
Data presented by Professor Sten Rubertsson indicate that performing prompt coronary angiography fails to enhance 30-day survival rates relative to a delayed approach among patients lacking ECG ST-elevation following an out-of-hospital cardiac arrest.
How many patients were included in the DISCO trial?
A total of 1,006 patients were included across 23 centers in Sweden, Denmark and the Netherlands.
What did the meta-analysis by Radboud University Medical Center reveal?
Examination of five randomized controlled trials—incorporating DISCO data and a combined total of 2,173 patients—spearheaded by Professor Niels van Royen and showcased by Ms Lente Pol, demonstrated identical 30-day survival outcomes regardless of whether patients underwent immediate coronary angiography.
Was there any difference in neurological recovery between the groups?
There were also no significant differences in secondary endpoints related to neurological recovery.
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