Direct or Subacute Coronary Angiography in Out-of-hospital Cardiac Arrest — a Prospective, Randomized Study (DISCO)

DISCO

Paziente / Popolazione Intervento / Esposizione Confronto Esito

In 1,003 comatose survivors of cardiac arrest without ST-elevation, immediate coronary angiography did not improve survival at 30 days compared with delayed, selective angiography.

N

1006pazienti

Disegno

Pragmatic, multicentre (Sweden, Denmark, Netherlands), open-label, 1:1 randomised trial of immediate coronary angiography versus standard care with angiography deferred (preferably ≥3 days) unless ischaemia or haemodynamic instability; 30-day primary follow-up, 6-month neurological, cognitive and cardiac follow-up; 80% power to detect an absolute 9-percentage-point difference in 30-day survival (45% to 54%)

Esito

Survival at 30 days

Rilevanza

2Importante — uno dei diversi pilastri.

RisultatoSurvival at 30 days 54.6% vs 53.6% (HR 0.95, 95% CI 0.74-1.21; P = 0.67). Neurological outcome and survival at 180 days did not differ either.

Rubertsson S, et al. Presented at ESC Congress 2026, Hot Line 12, 31 August.

Discussione e critica

The fifth randomised trial to ask whether a resuscitated patient without ST-elevation should go straight to the catheter laboratory, and the fifth to find that they need not: half survive either way. Immediate angiography was performed within 120 minutes and the comparator deferred beyond 72 hours unless the patient was unstable, so what is being tested is timing in a stable patient, not whether to look at the coronaries at all. Thirty-day survival in this population is driven by brain injury rather than by the culprit lesion, which is the most economical explanation for five neutral trials.