Impact of Robotic Percutaneous Coronary Intervention (R‐PCI) With and Without CCTA‐Guidance on Clinical Outcomes and Hospital Economics: A Single Center Registry

Abstract

BackgroundSeveral studies have confirmed the safety and efficacy of robotic assisted coronary interventions for simple and complex coronary lesions. However, in the real‐world clinical setting the currently available evidence is still inconclusive with regard to clinical outcomes. In terms of financial sustainability, the emerging use of pre‐PCI Coronary Computed Tomography Angiography (CCTA) may potentially impact the overall patient journey and related costs. However, the role of CCTA guidance in elective robotic‐assisted revascularizations and its potential impact on hospital economics has never been investigated. Therefore, we aimed to assess the clinical impact of R‐PCI according to procedural complexity and its potential financial sustainability when integrated with CCTA guidance.MethodsMajor adverse cardiovascular events (MACE) at the latest clinical follow‐up available have been prospectively evaluated in a single center cohort of 111 patients undergoing elective R‐PCI (CorPath, Corindus GRX Robotic Drive, Boston, MA). The study population was subsequently divided into two groups according to either the median Syntax Score (SS = 14) as a surrogate of procedural complexity or the adoption of CCTA‐guidance. Additionally, both periprocedural and in‐hospital outcomes have been investigated in the overall cohort and in the subgroups.ResultsOverall, MACE occurred in 5.4% of the patients at a median follow‐up of 309 days. Procedural complexity was associated with significantly longer procedural time and radiation exposure (SS ≥ 14: 94.5 ± 32.1 vs. 78.7 ± 25.5 min, p = 0.011, and 32.7 ± 30.9 vs. 22.5 ± 19.8 mSv, p = 0.010, respectively), but not with increased in‐hospital and long‐term clinical outcomes. Additionally, patients undergoing CCTA‐guided R‐PCI had a significantly higher rate of same‐day‐discharge (SDD—64.6% vs. 44.2% respectively, p = 0.034) than those without CCTA support.ConclusionR‐PCI appears safe and effective regardless the procedural complexity. Moreover, the integration of robotics and CCTA‐guidance appears to have beneficial impact on hospital economics by optimizing resource utilization and improving patient selection for percutaneous revascularization.