title: Pre-discharge stress echocardiography and exercise ECG for risk stratification after uncomplicated acute myocardial infarction: results of the COSTAMI-II (cost of strategies after myocardial infarction) trial.
abstract: OBJECTIVE
  To compare in a prospective, randomised, multicentre trial the relative merits of pre-discharge exercise ECG and early pharmacological stress echocardiography concerning risk stratification and costs of treating patients with uncomplicated acute myocardial infarction.
  
  
  METHODS
  262 patients from six participating centres with a recent uncomplicated myocardial infarction were randomly assigned to early (day 3-5) pharmacological stress echocardiography (n = 132) or conventional pre-discharge (day 7-9) maximum symptom limited exercise ECG (n = 130).
  
  
  RESULTS
  No complication occurred during either stress echocardiography or exercise ECG. At one year follow up there were 26 events (1 death, 5 non-fatal reinfarctions, 20 patients with unstable angina requiring hospitalisation) in patients randomly assigned to early stress echocardiography and 18 events (2 reinfarctions, 16 unstable angina requiring hospitalisation) in the group randomly assigned to exercise ECG (not significant). The negative predictive value was 92% for stress echocardiography and 88% for exercise ECG (not significant). Total costs of the two strategies were similar (not significant).
  
  
  CONCLUSIONS
  Early pharmacological stress echocardiography and conventional pre-discharge symptom limited exercise ECG have similar clinical outcome and costs after uncomplicated infarction. Early pharmacological stress echocardiography should be considered a valid alternative even for patients with interpretable baseline ECG who can exercise.
authors.affiliation: Cardiovascular Research Foundation, S Giacomo Hospital, 31033 Castelfranco Veneto, Italy. aldesi@tin.it
authors.forename: A
authors.initials: A
authors.lastname: Desideri
authors.forename: P M
authors.initials: PM
authors.lastname: Fioretti
authors.forename: L
authors.initials: L
authors.lastname: Cortigiani
authors.forename: G
authors.initials: G
authors.lastname: Trocino
authors.forename: C
authors.initials: C
authors.lastname: Astarita
authors.forename: D
authors.initials: D
authors.lastname: Gregori
authors.forename: J
authors.initials: J
authors.lastname: Bax
authors.forename: J
authors.initials: J
authors.lastname: Velasco
authors.forename: L
authors.initials: L
authors.lastname: Celegon
authors.forename: R
authors.initials: R
authors.lastname: Bigi
authors.forename: S
authors.initials: S
authors.lastname: Pirelli
authors.forename: E
authors.initials: E
authors.lastname: Picano
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D025401:Echocardiography, Stress / Q000191:economics / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005060:Europe; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000191:economics; D009204:Myocardial Revascularization / Q000191:economics / Q000592:standards; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors