Aims To assess the outcome and costs of patients with acute myocardial infarction (AMI) after initial admission to hospitals with or without catheterization facilities in Belgium. Methods and results From a nationwide hospital register, we retrieved the data of 34 961 patients discharged during 1999–2001 with a principal diagnosis of AMI. They were initially admitted to hospitals without catheterization facilities (A), with diagnostic (B1) or interventional catheterization facilities (B2). Mortality has been recorded till the end of 2003 and re-admissions till the end of 2001. The mortality hazard ratio and 95% CI of 5 years mortality of A vs. B2 was 1.01 (0.97, 1.06) and of B1 vs. B2 was 1.03 (0.98, 1.09). Re-admission rates and 95% CI for cardiovascular reason per 100 patient-years were 23.5 (22.7, 24.3) for A, 23.8 (22.5, 25.1) for B1, and 22.0 (21.2, 22.9) for B2. The mean cost in hospital of a patient at low risk with a single stay was in A E4072 (median: 3,861; IQR: 4467–3476), in B1 E5083 (median: 5153; IQR: 5769–4340), and in B2 E7741 (median: 7553; IQR: 8211–7298). Conclusion Services with catheterization facilities compared with services without them showed no better health outcomes, but delivered more expensive care.