Robotic percutaneous coronary intervention and the clinical effectiveness debate: Is newer always better? A systematic review and frequentist network meta-analysis.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.