Hiram G Bezerra1, Emile Mehanna1, George W Vetrovec2, Marco A Costa1, Giora Weisz3,4. 1. Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio. 2. Division of Cardiology, VCU Pauley Heart Center, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia. 3. The Els and Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel. 4. Center for Interventional Vascular Therapy, New York Presbyterian Hospital, Columbia University Medical Center, New York City, New York.
Abstract
OBJECTIVES: To evaluate the impact of robotic-assisted percutaneous coronary intervention (RA-PCI) versus manual PCI (M-PCI) on the incidence of Longitudinal Geographic Miss (LGM). BACKGROUND: The safety and feasibility of RA-PCI has been established in preclinical animal trials and human clinical trials. Patients with LGM have been shown to have worse clinical outcomes including significantly increased incidences of MACE. METHODS: Patients with significant coronary artery disease underwent RA-PCI in the PRECISE study (n=164) and standard M-PCI in the STLLR trial (n = 1,509). Longitudinal geographic miss was defined as cases where the entire length of the injured or stenotic segment was not fully covered by the total length of the stent. The incidence of LGM was compared between RA-PCI and M-PCI cohorts. RESULTS: The RA-PCI cohort had a significantly greater prevalence of previous MI, previous coronary revascularization, and unstable angina. The robotic cohort exhibited a lower incidence of LGM when compared to the M-PCI patients, 12.2% to 43.1%, respectively (P < 0.0001). To account for the differences in baseline characteristics between the two studies, a propensity score analysis was conducted. The propensity modeling showed similar rates of LGM in both a larger group of patients that met key PRECISE study inclusion/exclusion criteria adjusted for propensity score (9.3% vs 55.0%; P < 0.0001) and in a smaller, matched on propensity score, subset of patients (10.3% vs 64.1%; P < 0.0001). CONCLUSION: Robotic-assisted PCI had significantly lower incidence of LGM compared to standard M-PCI. Reducing LGM potentially improves long-term clinical outcomes through reduction in MACE.
OBJECTIVES: To evaluate the impact of robotic-assisted percutaneous coronary intervention (RA-PCI) versus manual PCI (M-PCI) on the incidence of Longitudinal Geographic Miss (LGM). BACKGROUND: The safety and feasibility of RA-PCI has been established in preclinical animal trials and human clinical trials. Patients with LGM have been shown to have worse clinical outcomes including significantly increased incidences of MACE. METHODS:Patients with significant coronary artery disease underwent RA-PCI in the PRECISE study (n=164) and standard M-PCI in the STLLR trial (n = 1,509). Longitudinal geographic miss was defined as cases where the entire length of the injured or stenotic segment was not fully covered by the total length of the stent. The incidence of LGM was compared between RA-PCI and M-PCI cohorts. RESULTS: The RA-PCI cohort had a significantly greater prevalence of previous MI, previous coronary revascularization, and unstable angina. The robotic cohort exhibited a lower incidence of LGM when compared to the M-PCI patients, 12.2% to 43.1%, respectively (P < 0.0001). To account for the differences in baseline characteristics between the two studies, a propensity score analysis was conducted. The propensity modeling showed similar rates of LGM in both a larger group of patients that met key PRECISE study inclusion/exclusion criteria adjusted for propensity score (9.3% vs 55.0%; P < 0.0001) and in a smaller, matched on propensity score, subset of patients (10.3% vs 64.1%; P < 0.0001). CONCLUSION: Robotic-assisted PCI had significantly lower incidence of LGM compared to standard M-PCI. Reducing LGM potentially improves long-term clinical outcomes through reduction in MACE.