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.

Automated summary

An economic evaluation of the CROSS-AMI trial showed that SelR may be more efficient than ComR in patients with ST-segment elevation acute coronary syndrome and multivessel disease, as the costs during follow-up were lower in the SelR group.