Rescue Percutaneous Thrombectomy System Provides Better Angiographic Coronary Flow and Does Not Increase the In-Hospital Cost in Patients With Acute Myocardial Infarction

Abstract

In acute myocardial infarction (AMI), slow flow (<TIMI 3) after reperfusion remains a problem. Removing the thrombus from culprit lesions should reduce this phenomenon and improve clinical outcome, so to evaluate the advantages of the Rescue percutaneous thrombectomy system (Rescue PT), 65 cases of AMI in which Rescue PT (RT group) was carried out were compared with 66 cases of AMI that were treated before Rescue PT became available (non-RT group). The study compared angiographic results, in-hospital clinical outcomes and the cost estimation during hospitalization. In the RT group, direct stenting was chosen more frequently (57% vs 5%, p=0.002) and the number of balloon catheters used was less (0.7+/-0.8 vs 1.4+/-0.6, p<0.0001). The incidence of slow flow and the maximum serum creatine kinase value over 24 h were lower in the RT group (3.1% vs 19.7%, p=0.01 and 3444+/-2218 IU vs 4182+/-3010 IU, p<0.05 respectively); however, in-hospital clinical outcomes were identical. No major complication related to the Rescue PT procedure was found. The cost for the initial procedure and the total cost during hospitalization were similar between the groups. Thrombectomy with Rescue PT before mechanical dilatation of the culprit lesions is safe and feasible, even in the emergency clinical setting, and results in better angiographic coronary flow. This therapy facilitates direct stenting and does not increase the cost of treatment.

Predictors of Length of Hospital Stay After Acute Myocardial Infarction in Japan

“…Although data based on large-scale surveys are insufficient in Japan, the length of hospital stay after AMI has been shown to be 3-6 weeks. [10][11][12][13][14] In the middle of the 1990s, the length of hospital stay after AMI was 4-6 weeks 10,11 and by the late 1990s, it was 3-4 weeks in AMI patients treated with PCI within 12 h or 24 h after onset. 12,13 In the present study, the mean length of hospital stay was 29.2 days in patients treated with PCI within 12 h of onset and 30.5 days in those treated within 24 h of onset.…”

“…[10][11][12][13][14] In the middle of the 1990s, the length of hospital stay after AMI was 4-6 weeks 10,11 and by the late 1990s, it was 3-4 weeks in AMI patients treated with PCI within 12 h or 24 h after onset. 12,13 In the present study, the mean length of hospital stay was 29.2 days in patients treated with PCI within 12 h of onset and 30.5 days in those treated within 24 h of onset. Although the length of hospital stay seems to be longer than that in the previous studies, it is necessary to conduct a nation-wide survey to examine regional differences of the length of hospital stay after AMI.…”

“…[3][4][5] Since then, the hospital stay after AMI has reduced to the current length of approximately 1 week in Western countries. [6][7][8][9] In contrast, the length of stay after AMI remains at approximately 4 weeks in Japan, [10][11][12][13][14] and epidemiological data concerning the length of hospital stay after AMI, its predictors and trends based on a large-scale sample are still limited. The Osaka Acute Coronary Insufficiency Study (OACIS), a large registry of patients with AMI, was established in 1998 to assess clinical variables, therapeutic procedures and clinical events, and can provide important data about recent trends in the pattern of care.…”

Characteristics of the Pathological Images of Coronary Artery Thrombi According to the Infarct-Related Coronary Artery in Acute Myocardial Infarction

“…It is now possible to aspirate coronary arterial thrombi using coronary arterial thrombectomy, [7][8][9] and to evaluate the pathological images in vivo. 10,11 So we investigated the characteristics of the pathological images of coronary arterial thrombi according to the infarct-related coronary artery.…”

Identification of Uncomplicated Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…In contrast, although the length of hospital stay in Japan has gradually decreased, it is still extremely long, at approximately 4 weeks. [17][18][19][20][21][22] In a recent study, we showed that the length of hospital stay did not correspond appropriately to the severity of AMI. 22 These findings suggest that the hospital stay could be reduced without adverse effect for AMI patients in Japan.…”