Coronary stent infection: a systematic review

Abstract

Coronary stent infection (CSI) is the rarest complication associated with the percutaneous coronary intervention, occurring in less than 0.1% of cases. So far, all reported instances are limited to case reports. CSI presents itself in various, often confusing, ways in clinical settings. Therefore, the current systematic review summarizes reports of CSI's clinical presentations, causative pathogens, diagnoses and treatments. This systematic review considered three online databases, using reference lists as an additional source. All case reports or case series with stent infection in the coronary artery were included -however, reviews or commentaries, articles not published in English, and articles mentioning a history of hemodialysis or any surgery were excluded. Thirtytwo studies on 34 CSI patients were included in the final qualitative analysis. CSI predominantly affected males of a wide range of ages. The most common symptoms were chest pain and fever with various onsets. Interestingly, CSI usually occurred during the first stent implantation. Cultures and coronary angiography were the most common methods used to diagnose CSI. Furthermore, drug-eluting stents had a higher risk of infection than bare-metal stents. Aneurysms were the most frequent abnormalities observed in infected stents. The bacteria that most often caused CSI were Staphylococcus aureus and Pseudomonas aeroginosa. More than 90% of the reports mentioned using various antibiotics, and 74% mentioned carrying out surgery. Finally, a mortality rate of 26.47% among CSI patients was calculated.

Leadless Pacemaker Infection Risk in Patients with Cardiac Implantable Electronic Device Infections: A Case Series and Literature Review

“…Additionally, 11 (55%) patients had positive lead cultures. Antimicrobial therapy was administered for a median time of 27 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] days after LP placement. The most common administered antimicrobial was daptomycin in 60% of cases.…”

“…Another important characteristic that we must consider is the size; indeed, an LP has a surface area of 616 mm 2 that is much less than that of traditional lead. This feature, together with the complete encasement of the device in a collagen-rich matrix that reduces bacterial adhesion and biofilm production, may explain the extremely low risk of infection [27]. In addition, other characteristics that we must consider are the perylene coating, a material having an intrinsic resistance to bacterial adhesion, and the position in the right ventricle where the blood pressure is increased when compared to the right atrium.…”

Late Presentation of Right Coronary Artery Stent Infection as Left Empyema and Pleuropericardial Fistula

“…Coronary-cameral fistula, coronary perforation, delayed migration of stent, and soft-tissue density collection have also been reported. 1 , 8 …”

“…Despite early detection and optimal management, CSI carries high morbidity and mortality. 1 We report a late-presenting case of right coronary artery (RCA) stent infection with left empyema and pleuropericardial fistula, which is a very rare presentation ( Central Illustration ).

Learning Objectives

To describe the rare presentation and surgical approach for the management of coronary stent infection.

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Factors Influencing the Incidence of Pneumonia after Coronary Artery Bypass Grafting

“…The secretion in the lung cannot be discharged in time, and the ability to clear foreign pathogens is reduced. The catheter stays in the patient for a long time, more likely breeding bacteria and increasing the risk of lung infection [32].…”