Twelve-Month Clinical Outcomes of Robotic PCI vs Manual PCI: A Systematic Review
Abstract
Robotic-assisted Percutaneous Coronary Intervention (R-PCI) has been developed to improve procedural precision and reduce operator radiation exposure compared with Manual Percutaneous Coronary Intervention (M-PCI). Although short-term safety and feasibility have been well demonstrated, evidence on 12-month clinical outcomes remains limited. This systematic review evaluated 12-month clinical outcomes of R-PCI versus M-PCI in adult patients with coronary artery disease. Relevant literature published between January 2015 and April 2025 was identified through searches in Scopus, ScienceDirect, PubMed, Cochrane Library, and Google Scholar. Eligible studies directly compared R-PCI and M-PCI and reported 12-month clinical outcomes, including Major Adverse Cardiovascular Events (MACE), Myocardial Infarction (MI), stroke, mortality, and Target Vessel Revascularization (TVR). Four cohort studies were included, involving 915 patients, of whom 334 underwent R-PCI, and 581 underwent M-PCI. At 12 months, MACE rates ranged from 0% to 10.5% after R-PCI and 1.4% to 8.1% after M-PCI. Mortality, MI, and TVR were low and comparable between groups. Although fluoroscopy time varied among studies, procedural success remained high, and adverse events were similar between groups. Studies that utilized Intravascular Ultrasound (IVUS) guidance reported particularly favorable outcomes. Overall, the available observational evidence suggests that R-PCI is associated with 12-month clinical outcomes comparable to those of M-PCI. However, given the limited number of studies, their observational design, and the absence of randomized data, these findings should be interpreted with caution. Further large-scale randomized controlled trials with longer follow-up are warranted to more definitively establish the clinical effectiveness and cost-effectiveness of R-PCI.
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