A coronary stent may rarely become infected. The diagnosis may be delayed due to the infrequency of the condition.
Patient selection: history of coronary stent placement
Risk factors:
(1) procedure with multiple punctures
(2) arterial sheath placement > 24 hours
(3) placement of a drug eluting stent
Typical presentation:
(1) mlae > 50 years of age
(2) fever
(3) chest pain
Most common pathogens isolated in culture:
(1) Staphylococcus aureus
(2) coagulase negative Staphylococcus
(3) Pseudomonas aeruginosa
Criteria of Dieter for coronary stent infection:
(1) definitive: pathologic specimen of a coronary stent with evidence of infection
(2) possible - >= 3 of the following:
(2a) coronary stent placement <= 4 weeks before presentation
(2b) multiple repeat cardiac procedures using the same arterial sheath OR complications at site of arterial puncture.
(2c) bacteremia with positive blood cultures
(2d) temperature > 38.6°C in the absence of other infection
(2e) leukocytosis in the absence of other bacterial infection
(2f) acute coronary syndrome
(2g) cardiac imaging consistent with inflammation (including myocardial abscess)
