Coronary stent infection (CSI) may potentially be a preventable complication of percutaneous coronary intervention (PCI), but several larger studies are needed to understand unknown risk factors and clinical outcomes, a new meta-analysis shows. Nagendra Boopathy Senguttuvan, MBBS, MD, DM, of Sri Ramachandra Institute of Higher Education and Research in Porur, India, reported these findings Sunday during a Featured Clinical Science presentation at Cardiovascular Research Technologies (CRT) 2023 in Washington, D.C. A manuscript reporting these findings has been accepted for publication in Cardiovascular Revascularization Medicine. While CSI is a rare complication of PCI, it can be fatal. The optimal management process for CSI is still undetermined. This systematic review and meta-analysis examined the current literature on CSI and searched for potential management methods. In-hospital mortality was the primary outcome of this study. The investigators also developed an artificial intelligence (AI) model for the need for delayed surgery and probability of survival solely on medical therapy. The patient pool was made up of 79 subjects, 28 of whom had type II diabetes. Within the first week post-procedure, 43% of patients reported symptoms. Mycotic aneurysms were present in 62% of patients. The most common isolated organisms were Staphylococcus species (65% of patients). The study showed that 30.3% of patients with CSI died in the hospital. Univariate analysis showed that the presence of structural heart disease 83% mortality vs 17% survival, p = 0.009) and non-ST elevated acute coronary syndrome (11% mortality vs 88% survival, p = 0.03) were statistically significant predictors of in-hospital mortality. An analysis comparing patients with successful versus failed initial medical therapy showed that patients on medical therapy alone who were treated at private teaching hospitals had a greater chance of survival (80.0% vs 20.0%; p = 0.01, n = 10). Limitations of this study included the small sample size, negative publication bias, that the data recorded were limited to case reports and series, and that interpretation was challenging due to data from different eras and shortage of data on CSI in general. Overall, Senguttuvan noted that CSI is under-studied and under-reported, despite it being a potentially fatal complication of PCI. Recognizing CSI early and initiating appropriate treatments remain the standard for managing CSI until several important questions come to light from larger studies. Source: Ramakumar V, Thakur A, Abdulkader RS, et al. Coronary Stent Infections- A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med. 2023 Feb 26. (Article in Press) Image Credit: Jason Wermers/CRTonline.org