Procedural and Clinical Outcomes of Second-generation Robotic-assisted versus Manual Percutaneous Coronary Intervention: A 1-year Follow-up Study

Background: Robotic-assisted percutaneous coronary intervention (rPCI) offers potential benefits, including improved lesion assessment, optimised stent deployment and reduced radiation exposure. However, comparative data, particularly in Japanese populations, remain limited. Aim: To compare procedural and clinical outcomes between second-generation rPCI and manual percutaneous coronary intervention (mPCI) in patients with chronic coronary syndrome and acute coronary syndrome over a 1-year follow-up period. Methods: This retrospective cohort study included 176 patients who underwent rPCI using the second-generation CorPath GRX Vascular Robotic System. Following 1:1 propensity score matching at the lesion level, 176 patients were identified in the mPCI group. The co-primary endpoints were 1-year all-cause mortality and major adverse cardiovascular events, defined as a composite of cardiac death, non-fatal MI, target lesion revascularisation, stent thrombosis and stroke. Results: Both groups had similar baseline characteristics. Compared with mPCI, rPCI was associated with shorter total procedural time (26 minutes [19-37] versus 71 minutes [52-90]; p<0.01), fluoroscopy time (14 minutes [10-18] versus 16 minutes [10-26]; p=0.04), lower contrast volume (99 [82.8-129.0] versus 141 ml [116-172]; p<0.01) and lower dose area product (3,628.3 [2,552.1-5,352.3] versus 6,349.1 [4,080.0-8,382.3]; p<0.01). At 1 year, the co-primary endpoints of all-cause mortality (p=0.33) and major adverse cardiovascular events (p=0.79) were comparable between groups. Conclusion: Compared with mPCI, rPCI was associated with shorter procedural and fluoroscopy times, lower contrast volume and lower dose area product, while demonstrating similar clinical outcomes at 1 year.