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

doi:10.1016/j.carrev.2023.02.021

Coronary Stent Infections - A Systematic Review and Meta-Analysis

Cardiovasc Revasc Med. 2023 Sep:54:16-24. doi: 10.1016/j.carrev.2023.02.021. Epub 2023 Mar 8.

Affiliations

¹ Department of Cardiology, BLK-MAX Hospital, New Delhi, India.
² Department of Cardiology, National Cardiac Centre, Kathmandu, Nepal.
³ Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India.
⁴ Amsterdam University Medical Centre, Amsterdam, Netherlands.
⁵ Department of Clinical Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
⁶ Mayo Clinic College of Medicine, Rochester, USA.
⁷ Woodlands Health Campus, Singapore, Singapore.
⁸ Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai 600116, India.
⁹ Icahn School of Medicine, Mount Sinai, New York, USA.
¹⁰ Department of Cardiology, Sri Ramachandra Medical College and Research Centre, Chennai, India. Electronic address: drsnboopathy@gmail.com.

PMID: 36906449
DOI: 10.1016/j.carrev.2023.02.021

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).

Keywords: Coronary mycotic aneurysm; Coronary stent infection; Infective endocarditis; Percutaneous coronary infection.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Acute Coronary Syndrome* / diagnostic imaging
Acute Coronary Syndrome* / therapy
Artificial Intelligence
Diabetes Mellitus, Type 2* / complications
Humans
Percutaneous Coronary Intervention*
Stents / adverse effects
Treatment Outcome