COST COMPARISON OF IMMEDIATE ANGIOPLASTY VERSUS THROMBOLYSIS FOLLOWEDBY CONSERVATIVE THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - A RANDOMIZED PROSPECTIVE TRIAL

Objective: Immediate angioplasty and thrombolysis followed by conserva tive therapy are treatment strategies for acute myocardial infarction. The objective of this study was to compare the costs of these two str ategies during a 12-month period. Methods: Of 103 patients with acute myocardial infarction who sought medical assistance within 12 hours af ter onset of symptoms, 4 were excluded from analysis for various reaso ns, 51 received tissue plasminogen activator, and 48 underwent immedia te angioplasty as the initial revascularization strategy. The main out come determinants were direct monetary costs and indirect measures of costs, including duration of hospital stay and return to work. Results : No significant difference in monetary costs between the two initial treatment strategies could be demonstrated. A trend was noted toward a briefer hospital stay and fewer late in-hospital procedures for patie nts treated initially with immediate angioplasty. Other measures of in direct costs were not statistically different. Conclusion: The hypothe sis that thrombolysis followed by conservative therapy would be more c ost-effective than immediate angioplasty in the treatment of patients with acute myocardial infarction could not be substantiated. The two s trategies seem to have similar cost-effectiveness.