SCAI 2021: Robotic PCI achieves high clinical and technical success “in a wide spectrum of lesions”

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Ehtisham Mahmud

Robotic-assisted percutaneous coronary intervention (PCI) using the second-generation CorPath GRX (Corindus) system achieved high rates of clinical and technical success, across a wide spectrum of lesions. These were the conclusions of the PRECISION GRX study, presented at the Society for Cardiovascular Angiography and Interventions virtual scientific sessions (SCAI 2021, 28 April–1 May, virtual) by Ehtisham Mahmud (The University of California, San Diego, USA).

Mahmud commented that the success of the CorPath GRX system demonstrated the potential for robotic technologies to minimise the risk of occupational hazards faced by interventional cardiologists over time—particularly exposure to radiation and orthopaedic injuries related to the prolonged wearing of lead during procedures.

Robotics changes the way that PCI procedures are carried out, Mahmud said during his virtual presentation at SCAI, noting that the latest generation system allows the control of the guide catheter, guidewire, stent or balloon delivery systems, remotely, away from the tableside. “During the procedure you are seated,” he said. “You are not wearing your lead so you minimise the orthopaedic risk, and you are behind a cockpit, so not getting exposed to radiation. These facts have been very important, and in previous studies we have known that with robotic PCI radiation is reduced by 95% to the operator.”

PRECISION GRX was a prospective international multicentre registry study, which enrolled patients with obstructive coronary artery disease with clinical indications for PCI who were treated with using the robotic system. In total the study analysed data from 980 patients, with an average age of 65.4 years. The majority had indications for acute coronary syndrome (ACS, 31.6%), stable angina (29.1%) or had a positive stress test (25.7%), while a small number were indicated for heart failure or left ventricular dysfunction (11.6%) or ST-elevation myocardial infarction (STEMI, 2.7%).

The lesions treated were almost equally distributed across the left anterior descending coronary artery (LAD, 36.6%), left circumflex artery (LCx, 27%) and the right coronary artery (RCA, 32.8%), and there were a small proportion of left main or vein graft lesions (3.6%), Mahmud explained. Detailing the type of lesions treated,  he explained that almost 70% were Type B2 (23.3%) or C (45.5%). “That is important to take into context, because previous studies were limited to type A and B1, and in this study we tried to enrol a broad cohort of patients,” he added.

Turning to the results, Mahmud noted that clinical success—defined as procedural completion with <30% residual stenosis and the absence of a major adverse cardiovascular event (MACE)—was achieved in 98.2% of lesions treated, with no statistically significant difference from type A (98.2%) to type C (97.9%) lesions. Technical success—clinical success along with the absence of manual assistance or conversion—was achieved in 89.8% of patients, he reported, higher in type A (95.8%) and B1 (95.3%) lesions, and slightly lower in B2 (88.3%) and C (86.7%) lesions.

In-hospital MACE were not seen in a single patient, Mahmud reported, but said that there were residual stenoses >30%  in 1.9% of patients, and a series of other minor adverse events (2.3%). In a  small proportion of cases (15) the system suffered malfunction although this did not lead to any adverse events for a patient.

Concluding his presentation, Mahmud said: “The Corpath GRX system with the addition of the guide catheter control has been a new modification compared to previous devices and has minimised the need for manual assistance. These data support Robotic PCI being a viable option for addressing orthopaedic and radiation associated risks for the practice of interventional cardiology.”


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