Coronary Stent Infections — A Systematic Review and Meta-Analysis

Venkatakrishnan Ramakumar, Abhishek Thakur, Rizwan Suliankatchi Abdulkader, Bimmer Claessen, Asuwin Anandaram, Raj Palraj, Veeraraghavan Meyyur Aravamudan, Muralidharan Thoddi Ramamurthy, George Dangas, Nagendra Boopathy Senguttuvan

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Coronary stent infection (CSI) represents a rare but potentially fatal complication of percutaneous coronary interventions (PCI). A systematic review and meta-analysis of published reports was performed to profile CSI and its management strategies. Methods: Online database searches were performed using MeSH and keywords. The primary outcome of the study was in-hospital mortality. A unique Artificial Intelligence-based predictive model was developed for need for delayed surgery and probability of survival on medical therapy alone. Results: A total of 79 subjects were included in the study. Twenty eight (35.0 %) patients had type 2 diabetes mellitus. Subjects most commonly reported symptoms within the first week of the procedure (43 %). Fever was the most common initial symptom (72 %). Thirty eight percent of patients presented with acute coronary syndrome. The presence of mycotic aneurysms was described in 62 % of patients. Staphylococcus species were the most common (65 %) isolated organism. The primary outcome of in-hospital mortality was seen in a total of 24 patients out of 79 (30.3 %). A comparative univariate analysis comparing those encountering in-hospital mortality versus otherwise revealed the presence of structural heart disease (83 % mortality vs 17 % survival, p = 0.009), and the presence of non ST elevation acute coronary syndrome (11 % mortality vs 88 % survival, p = 0.03), to be a statistically significant factor predicting in-hospital mortality. In an analysis between patients with successful versus failed initial medical therapy, patients from private teaching hospitals (80.0 % vs 20.0 %; p = 0.01, n = 10) had a higher survival with medical therapy alone. Conclusion: CSI is a highly under-studied disease entity with largely unknown risk factors and clinical outcomes. Larger studies are needed to further define the characteristics of CSI. (PROSPERO ID CRD42021216031).

Original languageEnglish
Pages (from-to)16-24
Number of pages9
JournalCardiovascular Revascularization Medicine
Volume54
DOIs
StatePublished - Sep 2023

Keywords

  • Coronary mycotic aneurysm
  • Coronary stent infection
  • Infective endocarditis
  • Percutaneous coronary infection

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