Abstract Body (Do not enter title and authors here): Background. Robotic-assisted percutaneous coronary intervention (rPCI) shows promise for improved lesion assessment, stent deployment, and reduced radiation exposure for both operators and patients. However, comparative analyses between rPCI and manual PCI (mPCI) are still sparse, particularly in the Asian demographic.

Research question. Does rPCI offer equivalent or superior procedural and clinical outcomes compared with mPCI in Japanese patients with chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) during one year follow-up?

Methods. This retrospective cohort recruited 177 patients underwent rPCI using the second-generation CorPath GRX Vascular Robotic System at the Sapporo Cardiovascular Center, Hokkaido, Japan from October 2021 to May 2023. By propensity score matching (3:1), a control group of 468 patients who underwent mPCI from 2021-2022 was identified. Co-primary endpoints were one-year all-cause mortality and major adverse cardiovascular (MACE) as a composite of death, non-fatal MI, target lesion revascularisation, stent thrombosis, and stroke.

Results. Most patients in both rPCI (median age: 74; 74.5% male) and mPCI (median age: 75; 72.8% male) group were hypertensive (82.1% vs 81.3%, p=0.83), dyslipidemic (90.2% vs 92.4%, p=0.35), and had prior PCI (58.2% vs 52.0%, p=0.15). 736 lesions were treated (186 rPCI, 552 mPCI), with similar ACC/AHA classification but more CTO in the mPCI group (0% vs 4.7%; p<0.01). Compared to mPCI, rPCI procedures documented lower total procedural time (26 min [19.0-36.5] vs 77 min [59-98]; p<0.01), fluoroscopy time (14 min [10-18] vs 20 min [13-30]; p<0.01), contrast dose (100 ml [83.3-127.8] vs 145 ml [116-181]; p<0.01), and dose area product (3,723.6 [2,476.8-5,328.3] vs 6,704.9 [4,245.9-9,440.7]; p<0.01). At one-year, both co-primary endpoints of all-cause mortality (p=0.59) and MACE (p=0.85) were comparable between groups.

Conclusions. Among Japanese patients, rPCI was associated with lower procedural and fluoroscopy times, contrast agent dose, and dose area product with similar safety in clinical outcome compared with manual PCI at one-year follow up.