Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Cost of strategies after myocardial infarction (COSTAMI)
A multicentre, international, randomized trial for cost-effective discharge after uncomplicated myocardial infarction
a Cardiovascular Research Foundation, Castelfranco Veneto, Italy
b IRCAB Foundation, Udine, Italy
c Campo di Marte Hospital, Lucca, Italy
d IRCAB Foundation, Udine, Italy
e Santo Spirito Hospital, Roma, Italy
f IRCCS General Hospital, San Giovanni Rotondo, Italy
g General Hospital, Bari, Italy
h General Hospital, Bentivoglio, Italy
i University Medical Center, Leiden,The Netherlands
j Cardiovascular Research Foundation, Castelfranco Veneto, Italy
k Cardiovascular Research Foundation, Castelfranco Veneto, Italy
l CNR Institute of Clinical Physiology, Pisa, Italy
* Corresponding author: Alessandro Desideri, MD, FESC, FACC, Cardiovascular Research Foundation, S. Giacomo Hospital, 31033 Castelfranco Veneto (TV), Italy. Tel.: +39-0423-732300; fax: +39-0423-732301
E-mail address: aldesi{at}tin.it
Received 17 February 2003; revised 9 May 2003; accepted 21 May 2003
Aims Risk stratification after uncomplicated acute myocardial infarction is mostly applied by either symptom-limited post discharge exercise electrocardiography or pre-discharge submaximal exercise test. Aim of the present study was to determine if early pharmacological stress echocardiography and discharge within 24 hours of the test in cases without induced myocardial ischemia leads to lower costs and similar clinical outcome during 1 year follow up when compared to clinical evaluation and exercise electrocardiography after discharge.
Methods and results Four-hundred fifty-eight patients from 10 participating centers with a recent uncomplicated myocardial infarction were randomized to pharmacological stress echocardiography on day 3–5 followed by early discharge in the case of negative test result (early discharge strategy) (n=233) or clinical evaluation with hospital discharge on day 7–9 and symptom-limited post-discharge exercise electrocardiography at 2–4 weeks after myocardial infarction (usual care strategy) (n=225). At 1 year follow up there were 63 events (4 deaths, 9 non fatal reinfarctions, 50 chest pains requiring hospitalization) in patients randomized to early discharge, and 69events (6 deaths, 13 reinfarctions, 50 chest pains requiring hospitalization) in usual care (p=ns). Total median individual costs calculated on the basis of hospitalizations, investigations and interventions during 1 year follow up were 3561 for early discharge strategy vs 3850 for usual care strategy (p<0.05).
Conclusions Early pharmacological stress echocardiography followed by early discharge in case of negative test result gives similar clinical outcome and lower costs after uncomplicated myocardial infarction than clinical evaluation and delayed post-discharge symptom-limited exercise electrocardiography.
Key Words: Myocardial Infarction • early discharge • cost-benefit analysis
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  A Desideri, P M Fioretti, L Cortigiani, G Trocino, C Astarita, D Gregori, J Bax, J Velasco, L Celegon, R Bigi, et al. 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 Heart, February 1, 2005; 91(2): 146 - 151. [Abstract] [Full Text] [PDF]
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