Background

Robotic-assisted percutaneous coronary intervention PCI (rPCI) has proven feasible and safe in patients undergoing PCI. However, comparative analyses of rPCI vs. manual PCI (mPCI) are scarce. We therefore aimed to investigate procedural aspects and outcome of rPCI compared with mPCI.

Methods 

From 2015-2021, 3,012 patients undergoing coronary angiography were recruited in the INTERCATH study (NCT04936438), of whom 70 patients underwent rPCI using the 2nd generation CorPath GRX Vascular Robotic System at the University Heart & Vascular Center Hamburg-Eppendorf. By propensity score matching (for age, sex, BMI, diabetes mellitus, arterial hypertension, active smoking, low-density lipoprotein cholesterol, Gensini score and history of coronary artery bypass grafting operation), a control cohort of 210 mPCI patients was identified for a 1:3 comparison. Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) were excluded from current analysis. The primary end-points of the analysis were one-year all-cause mortality and target lesion revascularization.

Results

Overall, 280 patients were included for current analysis. Median age was 70.6 (IQR 62.6-77.8) years (23.8% female) in the mPCI vs. 71.5 (IQR 60.2-79.8) years (27.1% female) in the rPCI cohort. There were no differences regarding classical cardiovascular risk factors between the groups. At the time of presentation, the number of patients with non-STEMI were 12.9% (mPCI) and 14.3% (rPCI; p=0.84), respectively. In both groups, 14.3% had a medical history of coronary artery bypass grafting operation (p=1.00) and 49.0% (mPCI) vs. 58.6% (rPCI) had a history of PCI (p=0.21). Coronary artery disease (CAD) severity was similar between groups with 57.1% and 45.7% of patients suffering 3-vessel disease in the mPCI and rPCI subgroup, respectively (p=0.10). Calculated Gensini (28.0; IQR 15.5-47.0 vs. 28.5; IQR 16.2-48.1; p=0.78) and SYNTAX (12.5; IQR 7.0-19.8 vs. 11.5; IQR 7.0-18.6; p=0.86) scores also, showed no differences between mPCI vs. rPCI. During the PCI procedure, dose area product (mPCI: 2135.5; IQR 1230.8-3733.8 vs. rPCI: 2309.0; IQR 1632.2-4064.5 cGy*cm2; p=0.23) and total contrast fluid volume (mPCI: 147.5; IQR 100.0-190.0 vs. rPCI: 145.5; IQR 104.8-189.8 mL; p=0.98) did not differ, whilst longer fluoroscopy times (mPCI: 14.4; IQR 10.4-24.3 vs. rPCI: 19.8; IQR 13.8-27.2 min.; p=0.0015) were documented in the rPCI cohort (Table 1). After 12-month of follow-up neither all-cause mortality nor unplanned target lesion revascularization differed between the cohorts (Figure 1).

Conclusion

In this prospective and well-matched cohort study, rPCI was associated with slightly longer fluoroscopy times compared with mPCI, whilst dose area product and contrast fluid volume did not differ. One-year follow-up revealed no differences in all-cause mortality nor target lesion revascularization, supporting the safety of a robotic-assisted approach in patients with chronic coronary syndrome and non-STEMI acute coronary syndrome.