AIMS: To compare the inpatient costs and process quality in the treatment of acute myocardial infarction in France, Germany, Italy, The Netherlands, Sweden, Switzerland, and the U.K. METHODS: A total of 208 European hospitals assessed services for one hypothetical average patient with acute myocardial infarction (cost evaluation) and prospectively followed up one or two real acute myocardial infarction patients (quality evaluation) in 2000/2001. The following cost modules were evaluated: general medicine ward, critical care unit (both personnel costs only), and reperfusion therapy. The following process quality indicators were evaluated: reperfusion therapy; and prescription of aspirin, lidocaine, beta-blockers, and ACE inhibitors. RESULTS: Switzerland, Germany, and France had the highest reperfusion costs due to a relatively high percentage of patients receiving percutaneous transluminal coronary angioplasties, stents, and glycoprotein IIb/IIIa blockers. Personnel costs for general medicine wards and critical care units were highest in Italy and Germany due to relatively long hospital stays. Average quality ratings ranged from 89% in the U.K. and France to 96% in Germany. CONCLUSION: There was little variation in the process quality of care for treating acute myocardial infarction. Differences in resource use may result from differences in the types of reimbursement and in the rates of diffusion of new technology.