Impacto en la mortalidad tras la implantación de una red de atención al infarto agudo de miocardio con elevación del segmento ST. Estudio IPHENAMIC

Programa Oficial de Doutoramento en Ciencias da Saúde. 5007V01[Resumen] Introducción y objetivos: Existe poca evidencia acerca del impacto que las redes de atención al Síndrome Coronario Agudo Con Elevación del segmento ST (SCACEST), tienen sobre la población. El objetivo de este estudio fue averiguar si el Programa Gallego de Atención al Infarto Agudo de Miocardio (PROGALIAM) en la zona norte de Galicia, mejoró el pronóstico y consiguió la equidad no solo en términos de acceso a las mejores estrategias de reperfusión sino también en términos de supervivencia. Métodos: Se recogieron todos los eventos codificados en el Conjunto Mínimo Básico de Datos (CMBD), como SCACEST entre 2001 y 2013 en los hospitales del área norte del PROGALIAM. Se identificaron 6.783 pacientes, que fueron divididos en dos grupos en función del periodo en el que sufrieron el evento: pre-PROGALIAM (2001-2005); 2.878 pacientes y PROGALIAM (2006-2013); 3.905 pacientes. Resultados: En la etapa Pre-PROGALIAM, la mortalidad ajustada a 30 días, 12 meses y 5 años fue superior en la población global HR: 1,52 - 95% IC (1,31 - 1,77), p < 0,001; HR: 1,48 - 95% IC (1,31 - 1,69), p < 0,001; HR: 1,22 - 95% IC (1,14 - 1,29), p < 0,001, respectivamente. También se observó un incremento significativo en la mortalidad ajustada a 30 días, 12 meses y 5 años en cada una de las áreas antes de la implantación de la red. Las cifras para el área de A Coruña fueron HR: 1,27 - 95% IC (1,01 - 1,60), p = 0,0045; HR: 1,30 - 95% IC (1,07 - 1,58), p = 0,009; HR: 1,12 - 95% IC (1,02 - 1,23), p = 0,02, respectivamente. Para el área de Lugo: HR: 1,94 - 95% IC (1,49 - 2,51), p < 0,001; 1,66 - 95% IC (1,34 - 2,07), p < 0,001; 1,34 - 95% IC (1,2 - 1,49), p < 0,001, respectivamente. Y para el área de Ferrol: HR: 1,58 - 95% IC (1,1 - 2,24), p = 0,001); HR: 1,64 - 95% IC (1,23 - 2,19), p = 0,001); HR: 1,23 - 95% IC (1,10 - 1,40), p = 0,001), respectivamente. Antes de la implantación del PROGALIAM, las mortalidades a 30 días, 12 meses y 5 años era superiores en las áreas de Lugo: HR: 1,57 - 95% IC (1,26 - 1,96), p = 0,001; HR: 1,39 - 95% IC (1,40 - 1,68), p = 0,001; HR: 1,25 - 95% IC (1,05 - 1,49), p = 0,02 y Ferrol HR: 1,34 - 95% IC (1,06 - 1,74), p = 0,03; HR: 1,39 - 95% IC (1,12 - 1,73), p = 0,03; HR: 1,32 - 95% IC (1,13 - 1,55), p = 0,001, respectivamente, frente a las de A Coruña. Estas diferencias a 30 días, 12 meses y 5 años, desaparecieron tras el desarrollo de la red: Lugo vs A Coruña: HR 1,05; 95% IC (0,85-1,35), p=0,72; HR 1,12; 95% IC (0,91-1,37), p=0,27; HR 0,88; 95% IC (0,72-1,06), p=0,18; Ferrol vs Coruña: HR 1,10; 95% IC (0,82-1,47), p= 0,53); HR 1,13; 95% IC (0,88-1,43), p=0,33; HR 1,04; 95% IC (0,89-1,22), p=0,58, respectivamente. Conclusiones: El desarrollo del PROGALIAM en la zona norte de Galicia disminuyó la mortalidad a corto, medio y largo plazo de los pacientes que sufrieron un SCACEST tanto de forma global, como para cada una de las áreas. Antes de la implantación de la red, existían menos probabilidades de supervivencia en la fase aguda, a medio y largo plazo en los pacientes de las áreas de Lugo y Ferrol. Tras su desarrollo se produjo un incremento la equidad que equiparó las oportunidades de supervivencia en todas las áreas y en todos los marcos temporales estudiados.[Resumo] Introdución e obxectivos: Existe moi pouca evidencia sobre o impacto que teñen na poboación as redes asistenciais de Síndrome Coronaria Aguda con elevación do segmento ST (SCACEST). O obxectivo deste estudo foi coñecer se o Programa Galego de Atención ao Infarto Agudo de Miocardio (PROGALIAM) na zona norte de Galicia mellorou o prognóstico e conseguiu equidade non só no acceso ás mellores estratexias de reperfusión senón tamén en materia de supervivencia. Métodos: Recolléronse todos os eventos codificados no Conxunto Mínimo de Datos Básicos (CMBD), como SCACEST entre 2001 e 2013 nos hospitais da zona norte de PROGALIAM. Un total de 6.783 pacientes foron identificados e divididos en dous grupos en función do período no que sufriron o evento: pre-PROGALIAM (2001-2005); 2.878 pacientes e PROGALIAM (2006-2013); 3.905 pacientes. Resultados: Na etapa Pre-PROGALIAM, a mortalidade axustada aos 30 días, 12 meses e 5 anos foi maior na poboación global HR: 1,52 - IC 95% (1,31 - 1,77), p < 0,001; HR: 1,48 - IC 95 % (1,31 - 1,69), p < 0,001; HR: 1,22 - IC 95 % (1,14 - 1,29), p < 0,001 respectivamente. Tamén se observou un importante incremento da mortalidade axustada a 30 días, 12 meses e 5 anos en cada unha das zonas antes da implantación da rede. As cifras da área de ACoruña foron HR: 1,27 - IC 95% (1,01 - 1,60), p = 0,0045; HR: 1,30 - IC 95 % (1,07 - 1,58), p = 0,009; HR: 1,12 - 95% IC (1,02 - 1,23), p = 0,02, respectivamente. Para a área de Lugo: HR: 1,94 - IC 95% (1,49 - 2,51), p < 0,001; 1,66 - IC 95 % (1,34 - 2,07), p < 0,001; IC 1,34 - 95 % (1,2 - 1,49), p < 0,001, respectivamente. E para a área de Ferrol: HR: 1,58 - IC 95% (1,1 - 2,24), p = 0,001); HR: 1,64 - IC 95% (1,23 - 2,19), p = 0,001); HR: 1,23 - IC 95% (1,10 - 1,40), p = 0,001), respectivamente. Antes da implantación do PROGALIAM, a mortalidade aos 30 días, 12 meses e 5 anos era maior nas áreas de Lugo: HR: 1,57 - IC 95% (1,26 - 1,96), p = 0,001; HR: 1,39 - IC 95 % (1,40 - 1,68), p = 0,001; HR: 1,25 - IC 95% (1,05 - 1,49), p = 0,02 e Ferrol HR: 1,34 - IC 95% (1,06 - 1,74), p = 0,03; HR: 1,39 - IC 95 % (1,12 - 1,73), p = 0,03; HR: 1,32 - IC 95% (1,13 - 1,55), p = 0,001, respectivamente, fronte A Coruña. Estas diferenzas aos 30 días, 12 meses e 5 anos desapareceron tras o desenvolvemento da rede: Lugo vs A Coruña: HR 1,05; IC do 95 % (0,85-1,35), p=0,72; HR 1,12; IC 95% (0,91-1,37), p=0,27; HR 0,88; IC do 95 % (0,72-1,06), p=0,18; Ferrol vs A Coruña: HR 1,10; IC 95% (0,82-1,47), p= 0,53); HR 1,13; IC 95% (0,88-1,43), p=0,33; HR 1,04; IC do 95% (0,89-1,22), p=0,58, respectivamente. Conclusións: O desenvolvemento do PROGALIAM na zona norte de Galicia diminuíu a mortalidade a curto, medio e longo prazo dos pacientes que padecían SCACEST tanto a nivel global como para cada unha das zonas. Antes da implantación da rede, había menos posibilidades de supervivencia na fase aguda, a medio e longo prazo en pacientes das zonas de Lugo e Ferrol. Tras o seu desenvolvemento, produciuse un aumento da equidade que igualou as posibilidades de supervivencia en todos os marcos temporais estudados e para todos os ámbitos.[Abstract] Introduction and objectives: Very little is known about the impact that ST-segment Elevation Acute Myocardial Infarction (STEMI) care networks have on the population. The objective of this study was to find out if the Galician Acute Myocardial Infarction Care Program (PROGALIAM) in the northern area of Galicia, improved prognosis and achieved equity not only in terms of access to the best reperfusion strategies but also in terms of survival. Methods: All the events coded in the Minimum Basic Data Set (MBDS) as STEMI between 2001 and 2013 in the hospitals of the northern area of PROGALIAM were collected. A total of 6,783 patients were identified and divided into two groups based on the period in which they suffered the event: pre-PROGALIAM (2001-2005); 2,878 patients and PROGALIAM (2006-2013); 3,905 patients. Results: In the Pre-PROGALIAM stage, adjusted mortality at 30 days, 12 months and 5 years was higher in the global population HR: 1.52 - 95% CI (1.31 - 1.77), p < 0.001; HR: 1.48 - 95% CI (1.31 - 1.69), p < 0.001; HR: 1.22 - 95% CI (1.14 - 1.29), p < 0.001, respectively. A significant increase in mortality adjusted to 30 days, 12 months and 5 years was also observed in each of the areas before the implementation of the network. The figures for the A Coruña area were HR: 1.27 - 95% CI (1.01 - 1.60), p = 0.0045; HR: 1.30 - 95% CI (1.07 - 1.58), p = 0.009; HR: 1.12 - 95% CI (1.02 - 1.23), p = 0.02, respectively. For the Lugo area: HR: 1.94 - 95% CI (1.49 - 2.51), p < 0.001; 1.66 - 95% CI (1.34 - 2.07), p < 0.001; 1.34 - 95% CI (1.2 - 1.49), p < 0.001, respectively. And for the Ferrol area: HR: 1.58 - 95% CI (1.1 - 2.24), p = 0.001); HR: 1.64 - 95% CI (1.23 - 2.19), p = 0.001); HR: 1.23 - 95% CI (1.10 - 1.40), p = 0.001), respectively. Before the implementation of PROGALIAM, mortality at 30 days, 12 months and 5 years was higher in the Lugo areas: HR: 1.57 - 95% CI (1.26 - 1.96), p = 0.001; HR: 1.39 - 95% CI (1.40 - 1.68), p = 0.001; HR: 1.25 - 95% CI (1.05 - 1.49), p = 0.02 and Ferrol HR: 1.34 - 95% CI (1.06 - 1.74), p = 0.03 ; HR: 1.39 - 95% CI (1.12 - 1.73), p = 0.03; HR: 1.32 - 95% CI (1.13 - 1.55), p = 0.001, respectively, compared to A Coruña. These differences at 30 days, 12 months and 5 years disappeared after the development of network. The figures for Lugo vs. A Coruña were: HR 1.05; 95% CI (0.85-1.35), p=0.72; HR 1.12; 95% CI (0.91-1.37), p=0.27; HR 0.88; 95% CI (0.72-1.06), p=0.18; and for Ferrol vs. A Coruña: HR 1.10; 95% CI (0.82-1.47), p= 0.53); HR 1.13; 95% CI (0.88-1.43), p=0.33; HR 1.04; 95% CI (0.89-1.22), p=0.58, respectively. Conclusions: The development of PROGALIAM in the northern area of Galicia decreased the short-, medium-, and long-term mortality of patients who suffered STEMI both globally and for each of the areas. Before the implementation of the network, there were fewer chances of survival in the acute phase, in the medium and long term in patients from the areas of Lugo and Ferrol. After its development, there was an increase in equity that equalized the chances of survival in all the time frames studied and for all areas

Automatic multiscale vascular image segmentation algorithm for coronary angiography

[Abstract] Cardiovascular diseases, particularly severe stenosis, are the main cause of death in the western world. The primary method of diagnosis, considered to be the standard in the detection and quantification of stenotic lesions, is a coronary angiography. This article proposes a new automatic multiscale segmentation algorithm for the study of coronary trees that offers results comparable to the best existing semi-automatic method. According to the state-of-the-art, a representative number of coronary angiography images that ensures the generalisation capacity of the algorithm has been used. All these images were selected by clinics from an Haemodynamics Unit. An exhaustive statistical analysis was performed in terms of sensitivity, specificity and Jaccard. Algorithm improvements imply that the clinician can perform tests on the patient and, bypassing the images through the system, can verify, in that moment, the intervention of existing differences in a coronary tree from a previous test, in such a way that it could change its clinical intra-intervention criteria.Galicia. Consellería de Cultura, Educación e Ordenación Universitaria; GRC2014/049Ministerio de Economía y Competitividad; TIN2015-70648-

Redesign and performance of an automatic segmentation method

[Resumen] La información más relevante de las angiografías coronarias se extrae empleando técnicas de segmentación, que pueden ser automáticas, semiautomáticas o manuales. Existen numerosos algoritmos de segmentación vascular, obteniendo mejores resultados, por normal general, aquellos que emplean múltiples técnicas e imágenes a diferentes escalas para proporcionar los resultados requeridos. Se presenta un nuevo método de segmentación automatizado basado en el método manual de Hamarneh incluyendo un estudio estadístico que demuestra su idoneidad para el problema

Impacto en la mortalidad tras la implantación de una red de atención al infarto agudo de miocardio con elevación del segmento ST: Estudio IPHENAMIC

[Abstract] Introduction and objectives: Little is known about the impact of networks for ST-segment elevation myocardial infarction (STEMI) care on the population. The objective of this study was to determine whether the PROGALIAM (Programa Gallego de Atención al Infarto Agudo de Miocardio) improved survival in northern Galicia. Methods: We collected all events coded as STEMI between 2001 and 2013. A total of 6783 patients were identified and divided into 2 groups: pre-PROGALIAM (2001-2005), with 2878 patients, and PROGALIAM (2006-2013), with 3905 patients. Results: In the pre-PROGALIAM period, 5-year adjusted mortality was higher both in the total population (HR, 1.22, 95%CI, 1.14-1.29; P <.001) and in each area (A Coruña: HR, 1.12; 95%CI, 1.02-1.23; P=.02; Lugo: HR, 1.34; 95%CI, 1.2-1.49; P <.001 and Ferrol: HR, 1.23; 95%CI, 1.1-1.4; P=.001). Before PROGALIAM, 5-year adjusted mortality was higher in the areas of Lugo (HR, 1.25; 95%CI, 1.05-1.49; P=.02) and Ferrol (HR, 1.32; 95%CI, 1.13-1.55; P=.001) than in A Coruña. These differences disappeared after the creation of the STEMI network (Lugo vs A Coruña: HR, 0.88; 95%CI, 0.72-1.06; P=.18, Ferrol vs A Coruña: HR, 1.04; 95%CI, 0.89-1.22; P=.58. Conclusions: For patients with STEMI, the creation of PROGALIAM in northern Galicia decreased mortality and increased equity in terms of survival both overall and in each of the areas where it was implemented. This study was registered at ClinicalTrials.gov (Identifier: NCT02501070).[Resumen] Introducción y objetivos. Se sabe muy poco del impacto que las redes de atención del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tienen en la población. El objetivo de este estudio es averiguar si el PROGALIAM (Programa Gallego de Atención al Infarto Agudo de Miocardio) mejoró la supervivencia en la zona norte de Galicia. Métodos. Se recogieron todos los eventos codificados como IAMCEST entre 2001 y 2013. Se identificó a 6.783 pacientes, divididos en 2 grupos: pre-PROGALIAM (2001-2005), 2.878 pacientes, y PROGALIAM (2006-2013), 3.905 pacientes. Resultados. En la etapa pre-PROGALIAM, la mortalidad ajustada a 5 años fue superior tanto en la población total (HR = 1,22; IC95%, 1,14-1,29; p < 0,001), como en cada una de las áreas (A Coruña, HR = 1,12; IC95%, 1,02-1,23; p = 0,02; Lugo, HR = 1,34; IC95%, 1,2-1,49; p < 0,001, y Ferrol, HR = 1,23; IC95%, 1,1-1,4; p = 0,001). Antes del PROGALIAM, la mortalidad a 5 años en las áreas de Lugo (HR = 0,8; IC95%, 0,67-0,95; p = 0,02) y Ferrol (HR = 0,75; IC95%, 0,64-0,88; p = 0,001) era superior que en A Coruña. Estas diferencias desaparecieron tras el desarrollo de la red (Lugo comparado con A Coruña, HR = 0,88; IC95%, 0,72-1,06; p = 0,18; Ferrol comparado con A Coruña, HR = 1,04; IC95%, 0,89-1,22; p = 0,58. Conclusiones. El desarrollo del PROGALIAM en el área norte de Galicia disminuyó la mortalidad e incrementó la equidad de los pacientes con IAMCEST tanto en general como en cada una de las áreas donde se implantó. Estudio registrado en ClinicalTrials.gov (Identificador: NCT02501070)

Safety of statins when response is carefully monitored: a study of 336 heart recipients

[Abstract] Background. Statins are used as first-line drugs against hypercholesterolemia after heart transplantation. Randomized clinical trials have shown that they reduce cholesterol levels, and the incidence of rejection and coronary vasculopathy. Adverse effects have been related to the use of certain statins, high statin dosages, comorbidities, and coadministration with cyclosporine. However, estimation of the risk of adverse effects for a given patient is difficult. The aims of this study were to determine the incidence of various kinds of adverse effect of statins; to evaluate certain potential risk factors; and to assess the efficacy of early response to signs of adverse effects. Methods. Between April 1991 and December 2003, we retrospectively evaluated 336 heart transplant patients (including 55 women) with regard to the occurrence of possible adverse effects of statins (rhabdomyolysis, myalgia, hepatotoxicity, high CK without muscle symptoms, and others). Resolution on reduction of dosage or discontinuance and/or change of statin were deemed to constitute confirmation of cause. Relations were sought between adverse effects and age, sex, immunosuppressive therapy, kidney failure, body mass index (BMI), arterial hypertension, and diabetes mellitus. Results. Possible adverse events of statins were suffered by 60 patients, all of them men. The causal role of statins was confirmed in 41 (12.2% of all 336): hepatotoxicity was suffered by 13, high CK without muscle ache or weakness by 18, rhabdomyolysis by 5, myalgia by 3, and other effects by 2. The incidence of confirmed statin-related complications was higher among patients with BMI >29 kg/m2 than among those with lower BMI (P = .055). None of the patients with confirmed statin-related complications needed dialysis, none died, and permanent suspension of statin treatment was only necessary in 13 cases (3.9% of the 336). Conclusions. Some 10% to 20% of HT patients appear to suffer adverse side effects of initial statin therapy. However, early detection of such effects through diligent clinical and analytical monitoring allows the therapy to be modified in time to minimize the appearance of severe complications. In only a minority of cases permanent suspension of statin therapy is necessary

Prevalence, etiology, and outcome of catheterization laboratory false alarms in patients with suspected ST-elevation myocardial infarction

[Abstract] Introduction and objectives. To investigate the prevalence, causes and outcome of catheterization laboratory false alarms (CLFAs) in a regional primary angioplasty network. Methods. A prospective registry of 1,662 patients referred for primary angioplasty between January 2003 and August 2008 was reviewed to identify CLFAs (i.e. when no culprit coronary lesion could be found). Results. No culprit coronary lesion could be identified in 120 patients (7.2%; 95% confidence interval [CI], 5.9- 8.5%). Of these, 104 (6.3%, 95% CI, 5.1-7.4%) had a discharge diagnosis other than ST-elevation myocardial infarction, 91 (5.5%; 95% CI, 4.3-6.6%) had no significant coronary disease, and 64 (3.8%; 95% CI, 2.9-4.8%) tested negative for cardiac biomarkers. The most frequent alternative diagnoses were: previous Q-wave myocardial infarction (18 cases), nonspecific ST-segment abnormalities (11), pericarditis (10) and transient apical dyskinesia (10). The 30-day mortality rate was similar in patients with and without culprit lesions (5.8% vs. 5.8%; P=.99). The prevalence of CLFAs was slightly higher in patients not previously evaluated by a cardiologist and referred from emergency departments in hospitals without catheterization laboratories than in those referred by cardiologists from emergency departments at hospitals with such facilities (9.5% vs. 6.1%; P=.02; odds ratio=1.64; 95% CI, 1.08-2.5). The prevalence of CLFAs was not significantly higher in patients referred by physicians with out-of-hospital emergency medical services (7.2%; P=.51; odds ratio=1.37; 95% CI, 0.79-2.37). Conclusions. The prevalence of CLFAs was 7.2%, with the criterion of no culprit coronary lesion. Our findings suggest that different patterns of referral to catheterization laboratories could account for small variations in the prevalence of CLFAs.[Resumen] Introducción y objetivos. Determinar prevalencia, causas y pronóstico de las «falsas alarmas» al laboratorio de hemodinámica (FALH) en una red regional de angioplastia primaria. Métodos. Registro prospectivo de 1.662 pacientes remitidos para angioplastia primaria entre enero de 2003 y agosto de 2008. Se definió FALH como ausencia de lesión coronaria causal. Resultados. En 120 pacientes (7,2%; intervalo de confianza [IC] del 95%, 5,9-8,5) no se identificó ninguna lesión coronaria causal. De ellos, 104 (6,3%; IC del 95%, 5,1-7,4) recibieron un diagnóstico alternativo a IAMCEST, 91 (5,5%; IC del 95%, 4,3-6,6) no presentaron enfermedad coronaria significativa y 64 (3,8%; IC del 95%, 2,9-4,8) presentaron marcadores de daño miocárdico negativos. Los diagnósticos alternativos más frecuentes fueron: infarto con onda Q previo (18 casos), alteraciones inespecíficas del segmento ST (11), pericarditis (10) y discinesia apical transitoria (10). La mortalidad a 30 días fue similar en los pacientes con y sin lesión causal (el 5,8 frente al 5,8%; p = 0,99). La prevalencia de FALH fue discretamente superior entre los pacientes remitidos desde los servicios de urgencias de hospitales no intervencionistas sin evaluación previa por un cardiólogo que entre los remitidos por cardiólogos desde el servicio de urgencias del hospital intervencionista (el 9,5 frente al 6,1%; p = 0,02; odds ratio [OR] = 1,64; IC del 95%, 1,08-2,5). No observamos un exceso de FALH entre los pacientes remitidos por médicos de UVI Móviles-061 (7,2%; p = 0,51; OR = 1,37; IC del 95%, 0,79-2,37). Conclusiones. Hemos observado una prevalencia de FALH del 7,2% de acuerdo con el criterio de ausencia de lesión coronaria causal. Nuestros resultados indican que diferentes modelos de activación del laboratorio de hemodinámica podrían justificar discretas variaciones en la prevalencia de FALH

Presence of Bacterial DNA in Thrombotic Material of Patients with Myocardial Infarction

[Abstract] Infectious agents have been suggested to be involved in etiopathogenesis of Acute Coronary Syndrome (ACS). However, the relationship between bacterial infection and acute myocardial infarction (AMI) has not yet been completely clarified. The objective of this study is to detect bacterial DNA in thrombotic material of patients with ACS with ST-segment elevation (STEMI) treated with Primary Percutaneous Coronary Intervention (PPCI). We studied 109 consecutive patients with STEMI, who underwent thrombus aspiration and arterial peripheral blood sampling. Testing for bacterial DNA was performed by probe-based real-time Polymerase Chain Reaction (PCR). 12 probes and primers were used for the detection of Aggregatibacter actinomycetemcomitans, Chlamydia pneumoniae, viridans group streptococci, Porphyromonas gingivalis, Fusobacterium nucleatum, Tannarella forsythia, Treponema denticola, Helycobacter pylori, Mycoplasma pneumoniae, Staphylococus aureus, Prevotella intermedia and Streptococcus mutans. Thus, DNA of four species of bacteria was detected in 10 of the 109 patients studied. The most frequent species was viridans group streptococci (6 patients, 5.5%), followed by Staphylococus aureus (2 patients, 1.8%). Moreover, a patient had DNA of Porphyromonas gingivalis (0.9%); and another patient had DNA of Prevotella intermedia (0.9%). Bacterial DNA was not detected in peripheral blood of any of our patients. In conclusion, DNA of four species of endodontic and periodontal bacteria was detected in thrombotic material of 10 STEMI patients. Bacterial DNA was not detected in the peripheral blood of patients with bacterial DNA in their thrombotic material. Bacteria could be latently present in plaques and might play a role in plaque instability and thrombus formation leading to ACS

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

[Resumen] Introducción y objetivos. Los estudios económicos pueden ayudar a tomar decisiones en el tratamiento de la enfermedad multivaso en el infarto. Se planteó realizar una evaluación económica del ensayo clínico CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction). Métodos. Se realizó un análisis de comparación de costes económicos de las estrategias (revascularización angiográfica completa [RCom] y revascularización selectiva guiada por isquemia en ecocardiograma de estrés [RSel]) comparadas en el ensayo clínico CROSS-AMI (N = 306), derivados de la hospitalización inicial y del primer año de seguimiento, según las tarifas oficiales vigentes en nuestro sistema de salud. Resultados. El coste de la hospitalización inicial resultó superior en el grupo de RCom que en la rama de RSel (19.657,9 ± 6.236,8 frente a 14.038,7 ± 4.958,5 euros; p < 0,001). No hubo diferencias entre ambos grupos en el coste del primer año de seguimiento (RCom, 2.423,5 ± 4.568,0 euros; Rsel, 2.653,9 ± 5.709,1 euros; p = 0,697). El coste total fue 22.081,3 ± 7.505,6 euros en la rama de RCom y 16.692,6 ± 7.669,9 euros en la rama de RSel (p < 0,001). Conclusiones. En el ensayo clínico CROSS-AMI, el sobrecoste inicial de la RCom frente a la RSel no se vio compensado por un ahorro significativo en el seguimiento. La RSel parece ser una estrategia más eficiente que la RCom para los pacientes con síndrome coronario agudo con elevación del segmento ST y enfermedad multivaso tratados mediante angioplastia emergente.[Abstract] 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 € vs 14 038.7 ± 4958.5 €; 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