Key result
Immediate angiography shows no 30-day survival benefit over deferred strategy in OHCA without ST-elevation.
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?
| Outcome | Immediate | Deferred |
|---|---|---|
| 30-day survival | 54.6% | 53.6% |
| Primary endpoint · HR 0.95 (95% CI 0.74-1.21); p=0.67 | ||
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.
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?
Hazard Ratio: 0.95 (95% CI 0.74–1.21)
Absolute Event Rate: 54.6% vs 53.6%
p-value: p=0.67
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.
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.
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.
“#ESCCongress 2026 Hot Lines: Primary results of the DISCO RCT - Direct or subacute coronary angiography for out-of-hospital cardiac arrest @AsherElad provides his take on the primary results of the DISCO trial, which were presented by Sten”
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.
Favors deferred angiography in resuscitated OHCA without ST-elevation; challenges routine immediate catheterization in guidelines.
DISCO randomised 1,006 unconscious adults with witnessed out-of-hospital cardiac arrest, return of spontaneous circulation, and no ST-elevation on prehospital or emergency ECG at 23 centres in Sweden, Denmark, and the Netherlands to immediate coronary angiography (within 120 minutes) or a deferred strategy intended to delay angiography at least 72 hours unless electrical or haemodynamic instability occurred. Mean age was 67 years and about one-quarter were women. 30-day survival was 54.6% with immediate angiography versus 53.6% with deferred angiography (HR 0.95, 95% CI 0.74 to 1.21; p=0.67). 180-day survival and neurological-recovery endpoints were likewise similar. Source: ESC Congress 2026 press, 31 August 2026.
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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).
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