[Treatment of acute myocardial infarction in Switzerland: is emergency PTCA more costly than thrombolysis?]. / Behandlungskosten des akuten Myokardinfarkts in der Schweiz: Ist die Akut-PTCA teurer als die Thrombolyse?

Confirming earlier studies with a lower number of patients, the Gusto IIb Angioplasty Substudy has shown that in the treatment of acute myocardial infarction emergency PTCA is superior to thrombolysis in reducing the combined clinical endpoints of death, reinfarction and cerebrovascular infarction. The aim of this study was to assess whether, in the Swiss study population of Gusto IIb, emergency PTCA was associated with higher procedural costs than thrombolysis over a median follow-up of 16 months. Therefore, we compared the costs of the initial and the follow-up hospitalisations. There were no differences in clinical characteristics in the Swiss subpopulation compared to the total study population. In a total of 46 patients, PTCA was performed in 22 and thrombolysis with rtPA in 24. During follow-up, 4 patients died, one in the PTCA group and 3 in the thrombolysis group (p = ns). The median total costs of the initial hospitalisation were somewhat higher in the PTCA group than in the group with thrombolysis. During follow-up only 38% of the patients in the PTCA group had to be rehospitalised, compared to 50% in the thrombolysis group. Median total costs within 16 months, therefore, were similar in the two therapeutic groups, but mean total costs per patient were somewhat lower for the PTCA versus the thrombolysis group (p = ns). Based on this comparison of Swiss procedural costs, emergency PTCA should not, in hospitals with the necessary infrastructure, be withheld in the treatment of acute myocardial infarction on the grounds of initially higher procedural costs, especially as the invasive strategy is associated with a more favourable long-term outcome.