BACKGROUND The Emory Angioplasty Versus Surgery Trial (EAST) is a randomized trial that compares, by intention to treat, the clinical outcome and costs of percutaneous transluminal coronary angioplasty (PTCA) and coronary surgery for multivessel coronary artery disease. RESULTS The primary end point was a composite of death, Q-wave myocardial infarction, and a large reversible thallium defect at 3 years. Multiple measures of quality of life also were made. Charges were assessed from the hospital UB-82 bills; professional charges were assessed from the Emory Clinic. Hospital charges were reduced to cost through step-down accounting methods. All costs and charges were deflated to 1987 dollars. Costs were assessed for the initial hospitalization and the cumulative costs of the initial hospitalization and additional revascularization procedures for up to 3 years. There was no difference in mortality or the primary end point. Mean initial hospital charges were $12,654 for the PTCA group and $20,214 for the surgery group (P < .0001). Professional charges were 4538 for PTCA and $9426 for surgery (P < .0001). Three-year hospital charges were $19,047 for PTCA and $21,174 for coronary surgery (P < .0001). Three-year professional charges were $6412 for PTCA and $9861 for surgery (P < .0001). Three-year total charges were $25,458 for PTCA and $31,033 for surgery (P < .0001). Total 3-year costs were $23,734 for PTCA and $25,310 for coronary surgery (P < .0001). There were more hospitalizations for angina and more antianginal medications used in the PTCA group, which would further narrow the differences in cost. CONCLUSIONS There was no difference in the primary end point or its components at 3 years. Although the primary procedural costs of coronary surgery are more than for coronary angioplasty, this cost advantage is largely, although probably not completely, lost by 3 years because of more frequent additional procedures and other resource consumption after a first revascularization by PTCA.