Coronary stent infection: Are patients amenable to surgical treatment? A systematic review and narrative synthesis

Objective: Coronary stent infection is a fearsome complication with high mortality rate. Since antibiotics may have only partial efficacy, invasive surgery may be needed. We present a systematic review about outcomes achieved by surgical versus medical treatment in this scenario. Methods: A literature search through Medline and Google Scholar was performed over a 30-years period according to PRISMA guidelines. Demographics, clinical data, imaging findings and treatment modalities were collected. Outcomes were analysed according to treatment. Results: Among 1727 articles identified, after duplicate removal the title/abstract screening excluded 821 articles. After full-text screening, 31 studies were included totalling 34 patients (n 28, 82.4% male, mean age 61.7 SD +/− 10 years old). The majority of infection were sustained by S. Aureus (n 28, 82.4%), occurred within one month (median 7 days, range 1–1440) from stenting and mostly over drug-eluting stents (n21, 61.8%). The majority of patients (n30, 88.2%) underwent antibiotics at first: 12 patients (35.3%) didn't undergo additional treatment because they died, were unfit or refused major surgery or responded favorably to medical treatment; surgery was scheduled in a total of 20 patients (58.8%), as an emergent approach (n2) or after failure of antibiotics (n18). More than half of patients medically treated died (n6/11, 54.5%) versus 35% (n7/20) in surgery group. Conclusions: Coronary stent infections are associated with high morbi-mortality rate. Medical treatment may be the only possible approach in extremely fragile patients, however timely surgical referral is the only definitive treatment, and it is recommended whenever possible.