Contemporary sirolimus-based stent platforms versus durable-polymer limus-eluting stents in patients with diabetes undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Introduction We performed a systematic review and meta-analysis of randomized evidence comparing sirolimus-based stent platforms with durable-polymer limus-eluting drug-eluting stents (DES) in patients with diabetes undergoing percutaneous coronary intervention (PCI).Methods PubMed/MEDLINE and Embase were searched through April 2026. Randomized trials and diabetic cohorts from randomized trials reporting approximately 1-year clinical outcomes were included; nonrandomized and surrogate-only reports were excluded. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Random-effects meta-analysis used restricted maximum likelihood estimation with Hartung-Knapp-Sidik-Jonkman confidence intervals.Results Eight randomized comparisons (5,988 patients) were included. Target lesion failure yielded a risk ratio (RR) of 1.14 (95% confidence interval [CI] 0.57–2.26; I2 = 79.4%); among everolimus-eluting comparators, RR was 1.49 (95% CI 1.03–2.14; I2 = 0%), favoring comparator DES. Target lesion revascularization yielded RR 1.46 (95% CI 0.66–3.25; I2 = 62.9%). Definite/probable stent thrombosis yielded RR 1.50 (95% CI 1.12–2.02), favoring comparator DES, although events were few. Death and target-vessel myocardial infarction estimates were imprecise.Conclusions Current evidence does not support preferential adoption of dedicated diabetic stent platforms over conventional durable-polymer DES. Longer-term trials are needed.Protocol registration www.crd.york.ac.uk/prospero identifier is CRD420261356994.