Angiography Does Not Improve 30-Day Survival After Cardiac Arrest

The DISCO trial, presented at the ESC Congress 2026, found that performing immediate coronary angiography in patients who suffered an out‑of‑hospital cardiac arrest and had no ST‑segment elevation on their ECG did not improve 30‑day survival compared with a strategy of deferring the procedure. In the randomized study, 1,200 patients were assigned to either early angiography within 90 minutes or to a delayed approach that reserved angiography for those who developed signs of coronary ischemia later. The primary endpoint—30‑day all‑cause mortality—was 18.4 % in the immediate‑angiography group and 18.9 % in the deferred‑angiography group, a difference that was not statistically significant.

A meta‑analysis of 12 trials with over 5,000 participants, which was also highlighted in the Hot Line session, corroborated the DISCO findings. Across the pooled data, early angiography did not reduce mortality, and the rate of major adverse cardiac events was similar between groups. The authors noted that the lack of benefit may reflect the low prevalence of culprit coronary lesions in this subset of cardiac arrest survivors and the potential harms associated with invasive procedures in critically ill patients. The ESC working group concluded that current evidence does not support a routine early angiographic approach for patients without ST‑segment elevation after out‑of‑hospital cardiac arrest, and that individualized clinical assessment remains essential.