First-in-human evaluation of an independently developed Chinese robot-assisted system for percutaneous coronary intervention

BACKGROUND Several studies have proved the safety and feasibility of robot-assisted percutaneous coronary intervention(PCI)in reducing the occupational hazards of interventionists while achieving precision medicine.However,an independently developed robot-assisted system for PCI in China has not yet emerged.This study aimed to evaluate the safety and feasibility of a robot-assisted system for elective PCI in China.METHODS This preclinical trial included 22 experimental pigs and preliminarily supported the safety and feasibility of the ETcath200 robot-assisted system for PCI.Then,eleven patients with coronary heart disease who met the inclusion criteria and had clinical indications for elective PCI were enrolled.PCI was performed using a robot-assisted system.The primary outcomes were clinical success(defined as visual estimated residual stenosis<30%after PCI and no major adverse cardiovascular events during hospitalization and within 30 days after PCI)and technical success(defined as the ability to use the robot-assisted system to complete PCI successfully without conversion to the traditional manual PCI).RESULTS Eleven patients were included in this clinical trial.A drug-eluting stent with a diameter of 3 mm(interquartile range:2.75–3.5 mm)and a length of 26 mm(interquartile range:22–28 mm)was deployed in all patients.The clinical success rate was 100%,with no PCI-related complications and no in-hospital or 30-day major adverse cardiovascular events,and the technical success rate was 100%.CONCLUSIONS The results strongly suggest that the use of the independently developed robot-assisted system in China for elective PCI is feasible,safe,and effective.

Association between baseline platelet count and severe adverse outcomes following percutaneous coronary intervention

Objective The aim is to evaluate the association between baseline platelet count （PC） and severe adverse outcomes following percu- taneous coronary intervention （PCI） in current real-world practice. Methods A total of 18,788 patients underwent PCI with drug-eluting stents constituted the study population. Patients were categorized as having low （〈 150 × 1000μ.L）, normal （150-300 × 1000μL）, and high （≥ 300 × 1000μL） baseline PC. The primary endpoints included in-hospital and follow-up all-cause mortality. The secondary endpoint was major bleeding requiring a blood transfusion. Results In-hospital mortality rates for patients with low, normal, and high baseline PC were 0.6%, 0.4%, and 0.4%, respectively （P = 0.259）. Similarly, mortality rates during long-term follow-up （median 23.8 months） for patients with low, normal, and high baseline PC were 0.9%, 0.6%, and 0.7%, respectively （P = 0.079）. After multivariate adjustment, patients with low or high baseline PC tended to have similar risks for both in-hospital and follow-up mortality compared with the normal group. Subgroup analyses failed to demonstrate an independent prognostic value of baseline PC in specific population groups except patients who undwent transfemoral PCI. There was also no significant difference in the incidence of major bleeding requiring a blood transfusion in the low, normal, and high groups （0.5%, 0.3%, and 0.3%, respectively; P = 0.320）. After multivariate adjustment, low or high baseline PC did not signi- ficantly increase the risk of major bleeding. Conclusion There is no significant association between baseline PC and severe adverse out- comes following PCI in current real-world practice.

Application of Excimer Laser Coronary Atherectomy Guided by Optical Coherence Tomography in the Treatment of a Severe Calcified Coronary Lesion

To the Editor： A 73-year-old female was referred to our hospital for evaluation of unstable angina pectoris. She had a greater than 10-year history of hypertension. Coronary angiography （CAG） was performed in another hospital in March 2017, which showed diffuse calcific stenosis （about 90%） in the proximal and mid-left anterior descending （LAD） artery, 70% stenosis in the ostial obtuse marginal branch, and no apparent stenosis in the right coronary artery. The lesion in the LAD could not be intervened because the 2.0 mm×15.0 mm Sprinter balloon （Medtronic, USA） could not be expanded and the 2.5 mm×15.0 mm NC Sprinter balloon （Medtronic, USA） could not pass through the lesion.