Robotic Assisted versus Manual Percutaneous Coronary Intervention - Systematic Review and Meta-Analysis.
INTRODUCTION: Robotics in percutaneous coronary intervention (R-PCI) has been one such area of advancement where potential benefits may include reduced operator radiation exposure, improved outcomes, and reduced rate of adverse events. Limited data exist about the benefits of R-PCI vs. conventional manual PCI (M-PCI). We appraised the latest evidence in the form of a meta-analysis of observational and retrospective studies.
METHODS: A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant clinical studies. Summary effects were calculated using a DerSimonian and Laird random-effects model as the pooled odds ratio or mean differences with 95% confidence intervals. All studies adhering to the inclusion criteria of direct comparisons between R-PCI and M-PCI were evaluated.
RESULTS: Seven studies with a total of 2,230 patients were identified. There was significant decrease in the chest-level operator radiation exposure (MD= -442.32; 95% CI = -675.88 to -208.76), fluoroscopy time (MD = -1.46; 95% CI -2.92 to 0.00) and amount of contrast used (MD= -18.28; 95% CI -24.16 to -12.41) in the robotic group as compared to the manual group. PCI time and the procedural success rate was not statistically different between the two groups. Clinical outcomes of major adverse cardiac events, all-cause mortality, and myocardial infarction were not different between the two groups.
CONCLUSION: Robotic PCI is associated with reduced operator radiation exposure, fluoroscopy time, and amount of contrast used. While there is a significant reduction in the procedural characteristics with robotic PCI, the clinical outcomes are not different compared to manual PCI. R-PCI is safe and effective with potential benefits to both the operator and the patient simultaneously.
Published In/Presented At
Gupta, R., Malik, A. H., Chan, J., Lawrence, H., Mehta, A., Venkata, V. S., Aedma, S. K., Ranchal, P., Dhaduk, K., Aronow, W. S., Vyas, A. V., Mehta, S. S., Combs, W. G., Frishman, W. H., & Patel, N. C. (2022). Robotic Assisted versus Manual Percutaneous Coronary Intervention - Systematic Review and Meta-Analysis. Cardiology in review, 10.1097/CRD.0000000000000445. Advance online publication. https://doi.org/10.1097/CRD.0000000000000445
Medicine and Health Sciences
Department of Medicine, Cardiology Division