Key result
Biolimus-eluting stents cut 1-year cardiac death ~30% compared with sirolimus-eluting stents.
Why the study?
Biolimus-eluting stents combine a more lipophilic analogue with a biodegradable polymer that may enhance healing and reduce thrombosis, but whether these features improve survival and cardiac outcomes compared with sirolimus-eluting stents remained uncertain.
Does a biolimus-eluting stent reduce all-cause mortality, cardiac mortality, and stent thrombosis compared with a sirolimus-eluting stent in adult patients with coronary artery disease undergoing percutaneous coronary intervention?
Meta-Analysis (n=12,109)
Randomized controlled trials included
Yes
Does a biolimus-eluting stent reduce all-cause mortality, cardiac mortality, and stent thrombosis compared with a sirolimus-eluting stent in adult patients with coronary artery disease undergoing percutaneous coronary intervention?
In patients undergoing PCI, biolimus-eluting stents reduce 1-year cardiac mortality by 30% and 1-to-5-year stent thrombosis by 46% compared with sirolimus-eluting stents, while maintaining comparable rates of myocardial infarction, MACE, and target lesion revascularisation.
Supports biolimus-eluting stent preference in PCI; confirms and extends prior randomized evidence on cardiac death and late thrombosis.
Background: Sirolimus-eluting stents (SES) are a benchmark in percutaneous coronary intervention (PCI), while biolimus-eluting stents (BES), which combine a more lipophilic analogue with a biodegradable polymer, may enhance healing and reduce thrombosis. Whether these BES features translate into improved survival and cardiac outcomes compared with SES remains uncertain. Aims: We sought to perform a meta-analysis of randomised controlled trials evaluating BES compared with SES in adult patients undergoing PCI. Methods: This meta-analysis encompassed randomised and controlled clinical trials that directly compared BES with SES in the setting of percutaneous coronary intervention. A comprehensive literature search was performed across PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to June 2025. The main outcomes assessed were all-cause and cardiac mortality, while secondary endpoints included major adverse cardiovascular events (MACE), myocardial infarction, target lesion revascularisation (TLR), and stent thrombosis (ST). Outcomes were evaluated at <=1 year (early) and >1-5 years (midterm) using pooled risk ratios (RRs) with 95% confidence intervals (CIs) in random-effects models, with heterogeneity assessed by the I2 test. Results: Six trials (12,109 patients: 6,088 BES, 6,021 SES) were analysed. BES reduced 1-year cardiac death by 30% (RR 0.70, 95% CI: 0.52-0.93) and showed a non-significant 19% reduction in all-cause death (RR 0.81; p=0.058). MACE, myocardial infarction, and TLR were similar between stents across timepoints. BES showed a non-significant early increase in ST (RR 1.85; p=0.12) but a 46% reduction in late ST (RR 0.54, 95% CI: 0.33-0.88). Mortality rates converged after 1 year. Conclusions: BES offer a short-term reduction in cardiac mortality and late stent thrombosis compared with SES, with otherwise similar morbidity outcomes. These results support the short-term safety of BES and indicate a possible long-term thrombotic and cardiac survival benefit, warranting confirmation in longer-term trials.
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Suruagy-Motta et al. (2026) conducted a meta-analysis in Coronary artery disease undergoing percutaneous coronary intervention (n=12,109). Biolimus-eluting stent (BES) vs. Sirolimus-eluting stent (SES) was evaluated on Cardiac death at <=1 year (RR 0.70, 95% CI 0.52-0.93, p=0.015). Biolimus-eluting stents reduced 1-year cardiac death by 30% (RR 0.70, 95% CI 0.52-0.93) and late stent thrombosis by 46% (RR 0.54, 95% CI 0.33-0.88) compared with sirolimus-eluting stents.
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