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Shah D, Gupta K, Naik D, Bhavsar N. Late Presentation of Right Coronary Artery Stent Infection as Left Empyema and Pleuropericardial Fistula. JACC Case Rep 2023; 28:102117. [PMID: 38204552 PMCID: PMC10774822 DOI: 10.1016/j.jaccas.2023.102117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 01/12/2024]
Abstract
Coronary stent infection (CSI) is a rare but potentially life-threatening disease, the incidence of which has been on a rise over the past 2 decades. Surgery seems the treatment of choice, providing a definitive diagnosis of CSI and removing the source of infection, repairing aneurysms, and providing bypass vascular grafts if feasible. Thorough evaluation and a multidisciplinary approach lead to detection and a better outcome. We report a patient who presented with symptoms of heart failure and shock, who received a diagnosis of CSI complicated by empyema with pleuropericardial fistula. He was treated by stent removal and decortication.
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Affiliation(s)
- Dhiren Shah
- Department of Cardiac Surgery, Marengo CIMS Hospital, Ahmedabad, India
| | - Kishore Gupta
- Department of Cardiac Surgery, Marengo CIMS Hospital, Ahmedabad, India
| | - Dhaval Naik
- Department of Cardiac Surgery, Marengo CIMS Hospital, Ahmedabad, India
| | - Niren Bhavsar
- Department of Anaesthesia, Marengo CIMS Hospital, Ahmedabad, India
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Bertolino L, Florio LL, Patauner F, Gallo R, Peluso AM, Scafuri A, De Vivo S, Corrado C, Zampino R, Ruocco G, D’Onofrio A, Durante-Mangoni E. Leadless Pacemaker Infection Risk in Patients with Cardiac Implantable Electronic Device Infections: A Case Series and Literature Review. J Clin Med 2023; 12:7573. [PMID: 38137641 PMCID: PMC10743511 DOI: 10.3390/jcm12247573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Leadless pacemakers (LPs) have been proposed as a reimplantation strategy in pacing-dependent patients undergoing cardiac implantable electronic device (CIED) extraction for infection. In this study, we analysed the risk of LP infection when this device is implanted before lead extraction. (2) Methods: This was a retrospective study including patients who underwent LP implantation between 2017 and 2022. Patients were divided in two groups according to whether LP was implanted following CIED extraction for infection (Group 1) or other indications (Group 2). The primary aim was to describe the risk of LP infection. (3) Results: We included in this study 49 patients with a median age of 81 [20-94] years, mostly males (36, 73%). In Group 1 patients, 17 cases (85%) showed systemic CIED infections, and 11 (55%) had positive lead cultures. Most Group 1 cases (n = 14, 70%) underwent one stage of LP implantation and CIED extraction. Mortality rate during follow-up was 20% (nine patients). Patients were followed up for a median of 927 [41-1925], days and no cases of definite or suspected LP infections were identified. (4) Conclusions: The risk of LP infection was extremely low. LP appears as a potential option for reimplantation in this setting and should be considered in pacing-dependent patients at a high risk of CIED infection recurrence.
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Affiliation(s)
- Lorenzo Bertolino
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Letizia Lucia Florio
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Anna Maria Peluso
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
| | - Antonio Scafuri
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Stefano De Vivo
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Carmelina Corrado
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Giuseppe Ruocco
- Unit of Microbiology and Virology, AORN Ospedali dei Colli, Piazzale Ettore Ruggieri, 80131 Naples, Italy;
| | - Antonio D’Onofrio
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
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Ayyubi SAS, Rehman A, Fatima L, Ahmed M, Rehman MU, Zameer R, Malik J. Coronary Stent Infection: A Systematic Review of Literature. Cardiol Rev 2023:00045415-990000000-00180. [PMID: 38038434 DOI: 10.1097/crd.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Coronary stent infection is a rare yet serious complication of coronary artery stenting, with potentially significant morbidity and mortality. This systematic review aimed to comprehensively assess the available evidence on the diagnosis, management, and outcomes of coronary stent infection. A comprehensive search of electronic databases, including PubMed, Embase, Cochrane Library, and Scopus, was conducted from inception until March 2023, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1 case series and 41 case reports, covering a cumulative sample size of 44 patients, were included in the analysis. The predominant stent types were drug-eluting stents in 22 studies, bare-metal stents in 3 studies, and a combination of drug-eluting stents and bare-metal stents in 4 studies. Staphylococcus aureus was the predominant identified organism in microbiological profiles. Primary outcomes, including mortality, morbidity, and recurrence rates, were evaluated. The aggregate mortality rate across studies was 18%, underscoring the severity of coronary stent infections. Morbidity ranged from 3% to 60%, with a spectrum of complications such as sepsis, heart failure, and embolic events. Recurrence rates varied from 3% to 33%, emphasizing the importance of effective management. Treatment strategies encompassed antibiotics alone, antibiotics with stent removal, and antibiotics with stent retention, with the duration of antibiotic therapy ranging from 2 weeks to 12 months. The optimal management strategy remains uncertain due to limited high-quality evidence. Early diagnosis and treatment were emphasized as critical factors in improving outcomes. Prophylactic antibiotics during stenting procedures and increased awareness among healthcare providers were suggested as preventive measures.
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Ramakumar V, Thakur A, Abdulkader RS, Claessen B, Anandaram A, Palraj R, Aravamudan VM, Thoddi Ramamurthy M, Dangas G, Senguttuvan NB. Coronary Stent Infections - A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:16-24. [PMID: 36906449 DOI: 10.1016/j.carrev.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
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).
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Affiliation(s)
| | - Abhishek Thakur
- Department of Cardiology, National Cardiac Centre, Kathmandu, Nepal
| | | | | | - Asuwin Anandaram
- Department of Clinical Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Raj Palraj
- Mayo Clinic College of Medicine, Rochester, USA
| | | | | | - George Dangas
- Icahn School of Medicine, Mount Sinai, New York, USA
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Gupta K, Shah D, Naik D, Madan S, Shah D. Late presenting complicated coronary stent infection of left anterior descending artery with antero-posterior communication. Indian J Thorac Cardiovasc Surg 2023; 39:412-416. [PMID: 37346443 PMCID: PMC10279614 DOI: 10.1007/s12055-023-01508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 06/23/2023] Open
Abstract
Coronary stent infections (CSI) are rare but a potentially life-threatening disease, the incidence of which has been on a rise over the last two decades. We report the case of a patient who presented with episodes of fever and discharging sternal wound. The patient was diagnosed as CSI arising from the left anterior descending artery stent which was communicating anteriorly to the skin and posteriorly as lobar-fistula. He was treated by stent removal and plication of the fistula. Blood culture, culture of the pus and infected stent, and coronary angiography are the preferred diagnostic modalities, followed by positron emission tomography (PET) scan and cardiac magnetic resonance imaging (MRI) for delineating the extent of pathology. Surgery seems to be the treatment of choice, providing a definitive diagnosis of CSI and removing the source of infection, repairing aneurysms, and providing bypass vascular grafts if feasible. Thorough evaluation and a multidisciplinary approach with the institution of appropriate medical and surgical therapy lead to timely detection and good outcome.
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Affiliation(s)
- Kishore Gupta
- Department of Cardiac Surgery, Marengo CIMS Hospital, Science City Road, Ahmedabad, 380060 India
| | - Dhiren Shah
- Department of Cardiac Surgery, Marengo CIMS Hospital, Science City Road, Ahmedabad, 380060 India
| | - Dhaval Naik
- Department of Cardiac Surgery, Marengo CIMS Hospital, Science City Road, Ahmedabad, 380060 India
| | - Surabhi Madan
- Department of Medicine, Marengo CIMS Hospital, Ahmedabad, India
| | - Deepa Shah
- Department of Radiology, Marengo CIMS Hospital, Ahmedabad, India
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