Łajczak Paweł, Eltawansy Sherif, Obi Ogechukwu, Sahin Oguz Kagan, Ayesha Ayesha, Almendral Jesus, Selan Jeffrey, Apolito Renato, Elashery Ahmad, Łajczak Anna, Buczkowski Stanisław, Jóźwik Kamil, Nowakowski Przemysław, Janiec Julita, Żerdziński Krzysztof, Schincariol Michele
Medical University of Silesia, Katowice, Poland.
Jersey Shore University Medical Centre, Neptune, NJ, USA.
Cardiovasc Revasc Med. 2025 Jul;76:113-120. doi: 10.1016/j.carrev.2025.04.005. Epub 2025 Apr 3.
Robotic percutaneous coronary intervention (R-PCI) became a new addition to interventional cardiology. This frequentist network meta-analysis (NMA) aims to compare robotic devices used for R-PCI.
A systematic search was performed across PubMed, Scopus, Embase, and Web of Science. We included papers evaluating robot-assisted (RA) models, either head-to-head or compared to manual PCI (M-PCI). Random-effects frequentist NMA was performed to analyze clinical and radiation outcomes.
Nine papers were included. CorPath GRX R-PCI system had lower Air Kerma radiation compared to M-PCI (mean difference (MD) -610.09 [95 % confidence interval (CI) -787.67 to -432.51]). Additionally, the CorPath 200 model was inferior to CorPath GRX (MD 376.32 [95 % CI 63.86 to 688.78]). Low heterogeneity was observed (I = 24.9 %). Other outcomes, including clinical success, procedure time, fluoroscopy time, MACE, and contrast volume, were not statistically different between different R-PCI models or when compared to M-PCI. The risk of bias showed moderate concerns.
This NMA reveals a clear benefit of R-PCI in reducing radiation, with some evidence suggesting superior radiation reduction with newer CorPath models. However, we found no significant differences between robotic platforms or compared to M-PCI in terms of clinical success, procedure time, or other clinical outcomes. This raises important questions about the cost-effectiveness of R-PCI. Future research should focus on robust clinical trials and comprehensive cost-effectiveness analyses to justify the widespread adoption of R-PCI.
机器人经皮冠状动脉介入治疗（R-PCI）成为介入心脏病学的一项新内容。这项频率学派网状荟萃分析（NMA）旨在比较用于R-PCI的机器人设备。
在PubMed、Scopus、Embase和科学网进行了系统检索。我们搜索。我们纳入了评估机器人辅助（RA）模型的论文，这些模型要么是头对头比较，要么是与手动PCI（M-PCI）进行比较。采用随机效应频率学派NMA分析临床和放射学结局。
纳入9篇论文。与M-PCI相比，CorPath GRX R-PCI系统的空气比释动能辐射较低（平均差值（MD）-610.09 [95%置信区间（CI）-787.67至-432.51]）。此外，CorPath 200模型不如CorPath GRX（MD 37,6.32 [95% CI 63.86至688.78]）。观察到低异质性（I² = 24.9%）。其他结局，包括临床成功率、手术时间、透视时间、主要不良心血管事件（MACE）和造影剂用量，在不同的R-PCI模型之间或与M-PCI相比时，差异无统计学意义。偏倚风险显示存在中度担忧。
这项NMA显示R-PCI在减少辐射方面有明显益处，有证据表明新型CorPath模型在减少辐射方面更具优势。然而，我们发现机器人平台之间或与M-PCI相比，在临床成功率、手术时间或其他临床结局方面没有显著差异。这引发了关于R-PCI成本效益的重要问题。未来的研究应侧重于开展有力的临床试验和全面的成本效益分析，以证明R-PCI的广泛应用是合理的。
