Athena battled through a frightening health issue during Friday night's ROH Death Before Dishonor, revealing she suffered an asthma attack in the middle of her successful ROH Women's World Championship defense.

The long-reigning champion faced Hazuki in the main event from the historic 2300 Arena in Philadelphia, Pennsylvania. During the bout, footage showed Athena down at ringside as those around her attended to the situation.

Athena addressed what happened on X the following day, confirming she had experienced an asthma attack while the match was taking place.

“Yeah, so, had an asthma attack mid match. Glad my minions had my back!!! A major thank you to AEW and Ring of Honor staff for the quick response, keeping the Forever ROH Champ in peak condition.”

Despite the setback, Athena was able to continue and ultimately retain her championship in a match that lasted more than 30 minutes.

The closing sequence saw Athena connect with an O-Face on the floor before delivering another O-Face from the top rope to secure the pinfall victory. Following the match, Athena and Hazuki bowed to one another in a rare display of mutual respect from the champion.

The victory marked Athena's 38th successful defense of the ROH Women's World Championship.

Athena captured the title from Mercedes Martinez at ROH Final Battle in December 2022 and has now surpassed 1,350 days as champion, establishing the longest reign in the championship's history. She also remains without a pinfall or submission loss in singles competition since capturing the gold.

During the post-show media scrum, Athena reflected on the physical punishment she has endured throughout her historic championship run.

“During my championship reign, I’ve dislocated my kneecap, I’ve had severe sprains to my ankle, I had a severe injury to my neck.”

ROH Death Before Dishonor Full Results

Zero Hour

• Queen Aminata and Mina Shirakawa defeated Vertvixen and Viva Van
• El Phantasmo defeated Adam Brooks
• Komander defeated Soleil and AR Fox in a three-way match
• Hechicero and Brian Cage, accompanied by Rocky Romero and Trent Beretta, defeated Bustah and The Brain (Jordan Oliver and Alec Price)

Maya World also appeared during Zero Hour and delivered a promo aimed at Willow Nightingale ahead of their AEW Women's World Championship encounter on Collision.

Main Card

• ROH Trios Championships: Lethal Twist (Blake Christian, Jay Lethal and Lee Johnson) defeated The Outrunners (Turbo Floyd and Truth Magnum) and Dalton Castle to capture the championships
• ROH Women's Pure Championship: Deonna Purrazzo defeated Steph De Lander to retain
• ROH Women's Television Championship: Red Velvet defeated Zayda Steel, Marina Shafir and Skye Blue to retain
• ROH Pure Championship: Lee Moriarty defeated Katsuyori Shibata to retain
• ROH Tag Team Championships: Sky Team (Mistico and Mascara Dorada) defeated The Kingdom (Matt Taven and Mike Bennett), LFI (Sammy Guevara and The Beast Mortos) and Top Flight (Dante Martin and Darius Martin) to retain
• AEW Continental Challenge Cup Play-In: Daniel Garcia defeated Adam Priest
• ROH World Television Championship, Fight Without Honor: Action Andretti, accompanied by HOOK and Anthony Bowens, defeated Lio Rush to become the new champion
• ROH World Championship: Bandido defeated Nick Wayne to retain
• ROH Women's World Championship: Athena, accompanied by Billie Starkz and Diamante, defeated Hazuki to retain

Elsewhere on the show, The Kingdom and LFI surprisingly joined forces ahead of the four-way ROH Tag Team Championship match. After Sky Team successfully defended the titles, RPG Vice attacked the champions, resulting in several teams making their way to the ring.

Daniel Garcia's victory over Adam Priest earned him a Continental Challenge Cup quarterfinal match against Claudio Castagnoli on Collision. Garcia entered the play-in after Eddie Kingston was not medically cleared to compete.

There was also a late alteration to the ROH Pure Championship match. Nigel McGuinness was removed after he was not medically cleared, leading to Katsuyori Shibata stepping in to challenge Lee Moriarty.

For Athena, Death Before Dishonor added another chapter to a championship reign that has already rewritten the ROH record books, although this particular defense proved challenging for reasons that went far beyond her opponent.