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

Michele Mattia Viscusi; Konstantinos Bermpeis; Dario Tino Bertolone; Thabo Mahendiran; Marta Belmonte; Giulia Botti; Emanuele Gallinoro; Pasquale Paolisso; Emanuele Barbato; Dimitri Buytaert; Tatyana Storozhenko; Adriaan Wilgenhof; Jozef Bartunek; Marc Vanderheyden; Bernard De Bruyne; Carlos Collet; Jeroen Sonck; Eric Wyffels

doi:10.1002/ccd.31323

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

Catheter Cardiovasc Interv. 2024 Dec 6. doi: 10.1002/ccd.31323. Online ahead of print.

Authors

Michele Mattia Viscusi^{1

2}, Konstantinos Bermpeis¹, Dario Tino Bertolone^{1

2}, Thabo Mahendiran^{1

2

3}, Marta Belmonte^{1

2}, Giulia Botti¹, Emanuele Gallinoro^{1

2

3

4}, Pasquale Paolisso^{1

2

3

4}, Emanuele Barbato⁵, Dimitri Buytaert¹, Tatyana Storozhenko¹, Adriaan Wilgenhof^{1

2

3

4

5}, Jozef Bartunek¹, Marc Vanderheyden¹, Bernard De Bruyne^{1

2

3}, Carlos Collet¹, Jeroen Sonck¹, Eric Wyffels¹

Affiliations

¹ Cardiovascular Center Aalst, OLV-Hospital, Aalst, Belgium.
² Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
³ Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
⁴ Department of Biomedical and Clinical Sciences, IRCCS Ospedale Galeazzi Sant'Ambrogio, University of Milan, Milan, Italy.
⁵ Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.

PMID: 39641191
DOI: 10.1002/ccd.31323

Abstract

Background: Several 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.

Methods: Major 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.

Results: Overall, 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.

Conclusion: R-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.

Keywords: CCTA‐guided PCI; R‐PCI; clinical outcomes; hospital economics; robotic assisted revascularization.