Clinical paper| Volume 139, P253-261, June 2019

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Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)—An initial pilot-study of a randomized clinical trial



      The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the ‘DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest’ (DISCO) randomized controlled trial ( ID: NCT02309151).


      Resuscitated bystander witnessed OHCA patients >18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded.


      In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group.
      In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days.


      In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.


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        • Spaulding C.M.
        • Joly L.M.
        • Rosenberg A.
        • et al.
        Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.
        N Engl J Med. 1997; 336: 1629-1633
        • Millin M.G.
        • Comer A.C.
        • Nable J.V.
        • et al.
        Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: a systematic review and meta-analysis.
        Resuscitation. 2016; 108: 54-60
        • Zanuttini D.
        • Armellini I.
        • Nucifora G.
        • et al.
        Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest.
        Resuscitation. 2013; 84: 1250-1254
        • Callaway C.W.
        • Donnino M.W.
        • Fink E.L.
        • et al.
        Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S465-82
        • Nolan J.P.
        • Soar J.
        • Cariou A.
        • et al.
        European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015: section 5 of the European Resuscitation Council guidelines for resuscitation 2015.
        Resuscitation. 2015; 95: 202-222
        • Lemkes J.S.
        • Janssens G.N.
        • van der Hoeven N.W.
        • et al.
        Coronary angiography after cardiac arrest without ST-segment elevation.
        N Engl J Med. 2019; 380: 1397-1407
        • Abella B.S.
        • Gaieski D.F.
        Coronary angiography after cardiac arrest — the right timing or the right patients?.
        N Engl J Med. 2019; 380: 1474-1475
        • Desch S.
        • Freund A.
        • Graf T.
        • et al.
        Immediate unselected coronary angiography versus delayed triage in survivors of out-of-hospital cardiac arrest without ST-segment elevation: design and rationale of the TOMAHAWK trial.
        Am Heart J. 2019; 209: 20-28
        • Lagedal R.
        • Elfwen L.
        • James S.
        • et al.
        Design of DISCO-direct or subacute coronary angiography in out-of-hospital cardiac arrest study.
        Am Heart J. 2018; 197: 53-61
        • Rao A.K.
        • Pratt C.
        • Berke A.
        • et al.
        Thrombolysis in Myocardial Infarction (TIMI) Trial—phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase.
        J Am Coll Cardiol. 1988; 11: 1-11
        • Geri G.
        • Dumas F.
        • Bougouin W.
        • et al.
        Immediate percutaneous coronary intervention is associated with improved short- and long-term survival after out-of-hospital cardiac arrest.
        Circ Cardiovasc Interv. 2015; 8
        • Dumas F.
        • Bougouin W.
        • Geri G.
        • et al.
        Emergency percutaneous coronary intervention in post-cardiac arrest patients without ST-segment elevation pattern: insights from the PROCAT II registry.
        JACC Cardiovasc Interv. 2016; 9: 1011-1018
        • Kern K.B.
        • Lotun K.
        • Patel N.
        • et al.
        Outcomes of comatose cardiac arrest survivors with and without ST-segment elevation myocardial infarction: importance of coronary angiography.
        JACC Cardiovasc Interv. 2015; 8: 1031-1040
        • Thiele H.
        • Akin I.
        • Sandri M.
        • et al.
        PCI strategies in patients with acute myocardial infarction and cardiogenic shock.
        N Engl J Med. 2017; 377: 2419-2432
        • Tranberg T.
        • Lippert F.K.
        • Christensen E.F.
        • et al.
        Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest: a nationwide study.
        Eur Heart J. 2017; 38: 1645-1652
        • Bro-Jeppesen J.
        • Kjaergaard J.
        • Wanscher M.
        • et al.
        Emergency coronary angiography in comatose cardiac arrest patients: do real-life experiences support the guidelines?.
        Eur Heart J Acute Cardiovasc Care. 2012; 1: 291-301
        • Noc M.
        • Fajadet J.
        • Lassen J.F.
        • et al.
        Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European association for percutaneous cardiovascular interventions (EAPCI)/stent for life (SFL) groups.
        EuroIntervention. 2014; 10: 31-37