Cost and Cost-effectiveness of an Early Invasive vs Conservative Strategy for the Treatment of Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction

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Abstract
Patients presenting with unstable angina and non–ST-segment elevation myocardial infarction (UA/NSTEMI) account for approximately 1.4 million US hospital admissions annually in the United States and 2 million to 2.5 million worldwide.1,2 Two recent reports have presented economic results from trials comparing invasive and conservative management strategies, however the results of these trials may not apply to current US practice. The Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) trial took place prior to the routine use of 3,4 platelet glycoprotein (Gp) inhibition and coronary stenting, and the clinical results differ qualitatively from those of more contemporary trials. The Fast Revascularization During Instability in Coronary Artery Disease (FRISC II) trial,5,6 carried out more recently in Scandinavia, might not generalize in a straightforward manner to the United States.