Economic evaluation of complete revascularization versus stress echocardiography-guided revascularization in the STEACS with multivessel disease

Introduction and objectives: Economic studies may help decision making in the management of multivessel disease in the setting of myocardial infarction. We sought to perform an economic evaluation of CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction) randomized clinical trial. Methods: We performed a cost minimization analysis for the strategies (complete angiographic revascularization [ComR] and selective stress echocardiography-guided revascularization [SelR]) compared in the CROSS-AMI clinical trial (N = 306), attributable the initial hospitalization and readmissions during the first year of follow-up, using current rates for health services provided by our health system. Results: The index hospitalization costs were higher in the ComR group than in SelR arm (19 657.9 +/- 6236.8 (sic) vs 14 038.7 +/- 4958.5 (sic) ; P < .001). There were no differences in the costs of the first year of follow-up rehospitalizations between both groups for (ComR 2423.5 +/- 4568.0 vs SelR 2653.9 +/- 5709.1; P = .697). Total cost was 22 081.3 +/- 7505.6 for the ComR arm and 16 692.6 +/- 7669.9 for the SelR group (P < .001). Conclusions: In the CROSS-AMI trial, the initial extra economic costs of the ComR versus SelR were not offset by significant savings during follow-up. SelR seems to be more efficient than ComR in patients with ST-segment elevation acute coronary syndrome and multivessel disease treated by emergent angioplasty. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.