Discussion
Infective complications are rare after PCI. Less than thirty cases of coronary stent infection have been reported in the literature, most occurring during the four weeks following the procedure. In only few cases it did occur late. Staphylococcus aureus is by far the most common pathogen causing septic complications after PTCA [1]. Almost all untreated infected aneurysms in case of stent infection eventually lead to rupture [2].
Our patient presented seven years after PCI with an epicardial abscess. The exact mechanism behind this complication remains unclear. The most likely hypothesis is having bacteraemia that took origin from the dialysis catheter that seeded in the right coronary stent.
Coronary fistula in stent infection seldom happens. Only two similar cases were found in the literature [3,4]. Our case was unique in its late presentation, presence of coronary rupture, infected false aneurysm, and right atrial fistula formation.
Whatever the mechanism of stent infection is, it is always a life-threatening condition; all aseptic precautions should be taken to prevent this iatrogenic infection. We believe that the delay in surgical therapy in addition to the multiple comorbidities and the poor hemodynamic status our patient had, resulted in his poor outcome.