Department of Cardiovascular Surgery, Pineta Grande Hospital, Castel Volturno, Italy.
Department of Cardiovascular Surgery, Bichat Claude Bernard Hospital, Paris, France.
Int J Cardiol. 2021 Dec 1;344:40-46. doi: 10.1016/j.ijcard.2021.09.030. Epub 2021 Sep 22.
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.
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.
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.
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.
冠状动脉支架感染是一种死亡率极高的可怕并发症。由于抗生素可能只有部分疗效，可能需要进行侵入性手术。我们对这种情况下手术与药物治疗的结果进行了系统评价。
根据 PRISMA 指南，通过 Medline 和 Google Scholar 进行了为期 30 年的文献检索。收集了人口统计学、临床数据、影像学发现和治疗方式。根据治疗方法分析了结果。
在 1727 篇文章中，经过重复去除后，标题/摘要筛选排除了 821 篇文章。经过全文筛选，共纳入 31 项研究，共计 34 例患者（n=28，82.4%为男性，平均年龄 61.7 岁±10 岁）。感染大多由金黄色葡萄球菌（n=28，82.4%）引起，发生在支架置入后 1 个月内（中位数 7 天，范围 1-1440 天），且多发生在药物洗脱支架上（n=21，61.8%）。大多数患者（n=30，88.2%）首先接受抗生素治疗：12 例患者（35.3%）因死亡、身体不适或拒绝大手术或对药物治疗反应良好而未接受额外治疗；共有 20 例患者（58.8%）接受了手术治疗，其中 2 例为紧急手术，18 例为抗生素治疗失败后手术。经药物治疗的患者中，超过一半死亡（n=6/11，54.5%），而手术组为 35%（n=7/20）。
冠状动脉支架感染死亡率极高。在极其脆弱的患者中，药物治疗可能是唯一可行的方法，然而，及时的手术转诊是唯一的确定性治疗方法，只要可能，就建议进行手术。
