Cost comparison of immediate angioplasty versus thrombolysis followed by conservative therapy for acute myocardial infarction: a randomized prospective trial. Mayo Coronary Care Unit and Catheterization Laboratory Groups.
OBJECTIVE
Immediate angioplasty and thrombolysis followed by conservative therapy are treatment strategies for acute myocardial infarction. The objective of this study was to compare the costs of these two strategies during a 12-month period.


METHODS
Of 103 patients with acute myocardial infarction who sought medical assistance within 12 hours after onset of symptoms, 4 were excluded from analysis for various reasons, 51 received tissue plasminogen activator, and 48 underwent immediate angioplasty as the initial revascularization strategy. The main outcome 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 patients treated initially with immediate angioplasty. Other measures of indirect costs were not statistically different.


CONCLUSIONS
The hypothesis that thrombolysis followed by conservative therapy would be more cost-effective than immediate angioplasty in the treatment of patients with acute myocardial infarction could not be substantiated. The two strategies seem to have similar cost-effectiveness.
Reeder
G S
GS
Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN 55905.
Bailey
K R
KR
Gersh
B J
BJ
Holmes
D R
DR
Christianson
J
J
Gibbons
R J
RJ
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000628:therapy; D011446:Prospective Studies; D015912:Thrombolytic Therapy / Q000191:economics*; D010959:Tissue Plasminogen Activator / Q000191:economics* / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator