Clinical and technical outcomes of robotic versus manual percutaneous coronary intervention: A systematic review and meta-analysis

Abstract

Robotic percutaneous coronary intervention (R-PCI) is a promising medical procedure being used in clinical settings, which is thought to produce superior clinical and technical outcomes compared to the traditional manual approach. We performed a systematic review and meta-analysis to compare R-PCI to manual PCI (M-PCI). A systematic literature search was performed using Pubmed, Medline (Ovid), Google Scholar, SCOPUS, and Embase from inception until the end of August 2021. Keywords used were ''Robotic PCI'' and ''Robotic angioplasty.'' Twenty studies were included for the qualitative analysis and seven for the pooled meta-analyses. There was no significant difference between R-PCI and M-PCI groups in terms of clinical success (risk ratio: 1.01, 95% CI: 0.99-1.02, p=0.45) and procedure time (mean difference: 4.55, 95% CI: 0.08-9.02, p=0.05). Both contrast volume (mean difference: -15.27, 95% CI: -22.37 - -8.18, p<0.0001) and fluoroscopy time (mean difference: -1.26, 95% CI: -2.37 - -0.16, p=0.03) were significantly lower in the R-PCI group. Technical success rates in all studies were equal to or greater than 70% (mean: 93.1, SD: 7.8), with four studies reporting 100% success rates. Given the comparable clinical short-term safety of R-PCI to that of M-PCI and the high technical success rates across several large, high-quality cohort studies, the clinician can be reassured about the ability of robotic devices. However, randomized long-term data are warranted before making prospective conclusions on the clinical and technical merits of R-PCI and adopting it as part of standard coronary interventions.