Bioresorbable-polymer sirolimus-eluting stents versus durable-polymer everolimus-eluting stents in percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials with GRADE assessment.

BACKGROUND: Ultrathin bioresorbable-polymer sirolimus-eluting stents (BP-SES), including bioresorbable scaffolds (BRS), were developed to mitigate adverse events associated with durable-polymer everolimus-eluting stents (DP-EES). This study aims to compare the efficacy and safety of BP-SES versus DP-EES in patients undergoing percutaneous coronary intervention for de novo coronary artery lesions. METHODS: We searched PubMed, Embase, ScienceDirect and ClinicalTrials.gov from inception to May 2026 for randomised controlled trials (RCTs) comparing BP-SES or BRS with DP-EES. Random-effects models were used to pool risk ratios (RRs) or mean differences with 95% confidence intervals (CIs). RESULTS: Nineteen RCTs involving 18,501 patients were included. No significant differences were observed between BP-SES and DP-EES for target lesion failure (RR 1.15, 95% CI 0.74-1.79; I2 = 94%), target vessel failure (RR 0.93, 95% CI 0.84-1.03; I2 = 10%), cardiac death (RR 0.96, 95% CI 0.78-1.18), target vessel myocardial infarction (RR 0.89, 95% CI 0.77-1.03), clinically indicated target lesion revascularisation (RR 0.99, 95% CI 0.80-1.22). Binary restenosis was significantly higher in the BP-SES arm overall (RR 2.46, 95% CI 1.41-4.29; p = 0.001). CONCLUSIONS: Metallic BP-SES and DP-EES showed similar rates for most clinical endpoints. However, extreme heterogeneity and accrual of only 5.7% of the required information size render the evidence for target lesion failure inconclusive. Higher binary restenosis increased target lesion revascularisation with fully BRS indicate that these platforms are not interchangeable with contemporary metallic stents. Further large, long-term trials are required.