Long-Term Outcomes With Biodegradable Polymer Biolimus-Eluting Stents Versus Durable Polymer Everolimus-Eluting Stents for Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Abstract

Recent randomized controlled trials (RCTs) have reported long-term outcomes comparing biodegradable polymer biolimus-eluting stents (BP-BES) with durable polymer everolimus-eluting stents (DP-EES). This meta-analysis aims to evaluate the long-term outcomes of BP-BES versus DP-EES in patients undergoing percutaneous coronary intervention (PCI). Electronic databases were systematically searched through August 2025 to identify RCTs comparing BP-BES with DP-EES in PCI. The primary outcome was major adverse cardiovascular events (MACE). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Fourteen RCTs totaling 14,504 patients were included; 7684 (52.9%) received BP-BES, and 6820 (47.1%) received DP-EES. BP-BES was associated with a similar risk of MACE compared with DP-EES (RR 1.09, 95% CI 0.96-1.23; P = 0.17; I2 = 0.0%). No significant differences were observed for all-cause mortality (RR 1.06, 95% CI 0.94-1.18; P = 0.34), cardiovascular mortality (RR 1.11, 95% CI 0.93-1.32; P = 0.24), or myocardial infarction (RR 1.09, 95% CI 0.92-1.29; P = 0.31), with low heterogeneity across outcomes (I2 = 0.0%). Rates of target lesion failure, target vessel revascularization, and target lesion revascularization were also comparable between groups. Subgroup analyses by follow-up duration (≤1 year, 1-3 years, 5 years, and 10 years) demonstrated consistent results with no significant differences in MACE. In patients undergoing PCI, BP-BES demonstrates long-term clinical outcomes comparable to DP-EES. These findings support the long-term safety and effectiveness of BP-BES.