OBJECTIVE: The management of atherothrombotic patients is a heavy burden on the Health budget. As MI and IS patients need acute as well as chronic care, a 2-year period was considered for studying local treatment patterns and the resulting costs (hospital & ambulatory costs). The overall cost of managing an ischemic event (MI, IS) was divided in acute (Ac) and follow-up (Fup) costs over 2 years. METHODS: France(F), Belgium(B), Switzerland(CH), Sweden(SW), Italy(IT), Spain(SP), Portugal(P) and Australia(A) were involved in the study. The management of ischemic events was analyzed during the acute phase and the subsequent 6-month periods. A decision tree was used; assumptions concerning patient management and resources utilization were based on currently available local and international literature, official national statistics and local expert opinions (Delphi panel). The costing was performed by using Diagnostics Related Groups (IT, SW, P, A), hospital databases and national tariffs (F, B, CH, SP). RESULTS: Differences between countries about the average clinical management patterns for a 2-year period are shown. The economic impact concerns the overall cost (Ac +Fup) as well as the breakdown between Ac and Fup costs. For MI, overall costs range from 9513 Euros in Belgium to 18294 Euros in Austria. Weights of the follow-up costs, range from 33% in Portugal to 53% in Austria. For IS, overall costs range from 5607 Euros in Austria to 56370 Euros in Switzerland. Differences also concern the weight of the Fup costs (from 17% in Portugal to 75% in France). CONCLUSION: Differences in overall cost and cost breakdown can be explained by local treatment pattern specificities and by the availability of specific and well-adapted structures for patients rehabilitation. The follow-up of an ischemic event should not be neglected in the global economic burden assessment.