SWEDEN — The trial included a total of 1,006 patients who had a mean age of 67 years and around one-quarter were women. Researchers conducted the study in 23 centers in Sweden, Denmark and the Netherlands.

In the immediate group, percutaneous coronary intervention was recommended on the presumed culprit lesion, while non-culprit lesions were not to be treated during the acute procedure. In cases of electrical or haemodynamic instability, coronary angiography could be performed before 72 hours.

There was no difference between the groups for survival at 180 days. There were also no differences in secondary endpoints related to neurological recovery.

"With these results from the largest randomized trial investigating this clinical dilemma, we can now conclusively say that immediate coronary angiography after OHCA does not improve outcomes over a deferred strategy," stated Professor Sten Rubertsson. Researchers from Radboud University Medical Center conducted an individual patient data meta-analysis of five randomized controlled trials, which included DISCO and involved data from 2,173 patients. Ms Lente Pol presented that there was no difference in 30-day survival between patients who received immediate coronary angiography and those who did not in the meta-analysis. "These results show that we can safely delay coronary angiography in patients after OHCA without ST elevation," concluded Ms Lente Pol.

The DISCO trial was preceded by four smaller trials (PEARL, EMERGE, COACT, TOMAHAWK) that also failed to demonstrate survival benefits from immediate coronary angiography in OHCA patients without ST-elevation, though these were underpowered for survival outcomes. A study titled "Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)—An initial pilot-study of a randomized clinical trial" was published in 2019 in Resuscitation. A study titled "Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation" was published in 2020 in Circulation. The DISCO trial's methodology and results were presented in a Hot Line session at ESC Congress 2026, with full details published in a peer-reviewed journal alongside the meta-analysis.

Why It Matters

The findings address a clinical dilemma regarding the timing of invasive procedures for cardiac arrest survivors without specific ECG indicators. By demonstrating that a deferred strategy yields similar survival outcomes, the results suggest that healthcare systems can avoid immediate invasive procedures for this patient population without compromising survival rates.

The scale of the DISCO trial, involving over 1,000 patients across multiple countries, provides robust evidence where previous smaller trials were underpowered. The accompanying meta-analysis of more than 2,000 patients further reinforces the conclusion that immediate angiography does not offer a survival advantage in this context.

Timeline

On September 1, 2026, Associate Professor Simone Biscaglia said that traditional coronary angiography provides a two-dimensional picture of narrowed vessels, which is subjective since it is interpreted by the human eye. Also on September 1, 2026, he said that measuring the functional importance of additional blockages during the culprit procedure can be challenging.

On September 1, 2026, Associate Professor Simone Biscaglia said that they designed AIR-STEMI to test whether this approach could improve outcomes in STEMI patients with multivessel disease. On the same date, he concluded that functional coronary angiography allowed them to select and treat only those non-culprit lesions that were clinically important, reducing unnecessary procedures and the risk of complications.

On September 1, 2026, Associate Professor Simone Biscaglia said that by moving beyond visual estimation alone, this approach brings complete revascularization closer to precision medicine: treating the lesions that matter, while avoiding unnecessary PCI in lesions that do not appear to limit blood flow. He concluded on September 1, 2026, that these results support functional coronary angiography as a new strategy to make complete revascularization more selective, safer and more personalized in this high-risk population.

What's New

Further details emerged from Associate Professor Simone Biscaglia, who said that traditional coronary angiography provides a two-dimensional picture of narrowed vessels, which is subjective since it is interpreted by the human eye. He also said that they designed AIR-STEMI to test whether this approach could improve outcomes in STEMI patients with multivessel disease.

Associate Professor Simone Biscaglia concluded that functional coronary angiography allowed them to select and treat only those non-culprit lesions that were clinically important, reducing unnecessary procedures and the risk of complications. He also concluded that these results support functional coronary angiography as a new strategy to make complete revascularization more selective, safer and more personalized in this high-risk population.

How Sources Differ

On the topic of coronary angiography, doi.org referenced the 2019 Resuscitation study. The DISCO trial primary endpoint results showed no difference in the primary endpoint of survival at 30 days was observed between immediate and deferred coronary angiography in the DISCO trial (54.6% vs. 53.6%; hazard ratio 0.95; 95% confidence interval 0.74 to 1.21; p=0.67).

Concerning coronary angiography, doi.org cited the 2019 Resuscitation publication. The DISCO trial protocol exceptions specified that in cases of electrical or haemodynamic instability in the DISCO trial, coronary angiography could be performed before 72 hours.

Regarding coronary angiography, doi.org mentioned a study titled Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation was published in 2020 in Circulation. The DISCO trial randomization protocol stated that patients in the DISCO trial were randomized 1:1 to immediate coronary angiography within 120 minutes or to a deferred strategy intended to delay coronary angiography for at least 72 hours.