Precision or tradition? A bayesian meta-analysis of robotic vs. manual percutaneous coronary intervention

Abstract Background percutaneous coronary intervention (PCI) is a widely applied treatment of coronary artery disease. While manual PCI (M-PCI) remains traditionally used, robotic PCI (R-PCI) is rapidly growing in numbers, as robotic systems promise increased accuracy, lesser exposure for operators, and potential patient safety improvements. However, these aspects remain under debate and controversial. Traditional frequentist meta-analyses did not resolve these controversies, therefore more comprehensive Bayesian meta-analysis, which incorporates prior knowledge and accounts for uncertainty, offers an advanced method for evaluating the comparative outcomes of these interventions. Purpose the aim of this meta-analysis is to compare the procedural efficiency, radiation exposure, and clinical outcomes of R-PCI to M-PCI using a Bayesian meta-analysis framework. We seek to determine whether R-PCI provides significant advantages over M-PCI in terms of procedural time, fluoroscopy time, contrast use, radiation exposure, and clinical outcomes such as mortality and major adverse cardiovascular events (MACE). Methods a comprehensive literature search was conducted across multiple databases, including PubMed, Embase, and Cochrane Library, to identify studies comparing R-PCI and M-PCI. A Bayesian non-informative random-effects model was applied to synthesize the data, providing posterior estimates with credible intervals (Crl). Results a total of nine studies encompassing 3,435 cases (R-PCI and M-PCI) were included. No significant differences were observed between R-PCI and M-PCI in terms of procedure time (MD 5.99; 95% Crl -6.73 to 18.79), fluoroscopy time (MD -0.43; 95% Crl -2.62 to 1.62), contrast volume (MD -7.53; 95% Crl -19.95 to 5.7), or dose area product (MD -512.37; 95% Crl -1885.08 to 903.76). Additionally, there was no significant difference in one-year all-cause mortality (OR 0.71; 95% Crl 0.44 to 7.18) or MACE events (OR 0.55; 95% Crl 0.11 to 2.88). However, a significant reduction in radiation air kerma was observed with R-PCI (MD -466.12; 95% Crl -714.41 to -193.57), suggesting lower patient radiation exposure. Conclusion this Bayesian meta-analysis indicates that R-PCI offers comparable procedural efficiency and clinical outcomes to M-PCI, with no significant differences in key procedural parameters, contrast use, or major cardiovascular events. Importantly, R-PCI was associated with significantly lower radiation air kerma, which may be a critical factor in improving patient safety. While R-PCI does not appear to provide substantial advantages in procedural time or outcomes, its potential for reducing radiation exposure underscores its role as a valuable alternative to M-PCI. Further high-quality randomized trials are needed to refine these findings and evaluate long-term benefits.