Comparative Safety and Efficacy of Biodegradable and Durable Polymer Drug-Eluting Stents in Patients with Acute Coronary Syndrome: A Systematic Review and Updated Meta-Analysis

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Biodegradable-polymer drug-eluting stents (BP-DES) were designed to limit the chronic vessel inflammation and delayed healing linked to durable-polymer stents (DP-DES), but whether this translates into a real safety or efficacy advantage in acute coronary syndrome (ACS), a population with heightened thrombotic risk, remains unclear, especially over longer follow-up. We searched PubMed, Cochrane, and ClinicalTrials.gov through September 2025 for randomized controlled trials comparing BP-DES and second-generation DP-DES in ACS patients undergoing percutaneous coronary intervention. A random-effects model was used to pool risk ratios (RR) with 95% confidence intervals (CIs), with major adverse cardiovascular events (MACE) as the primary outcome. Ten RCTs (11 publications; 10,130 patients; follow-up 6 months to 5 years) met inclusion criteria. MACE did not differ significantly between groups (RR 0.93, 95% CI 0.70-1.24). No significant differences were found for target vessel or lesion revascularization, target lesion failure, all-cause or cardiac death, target-vessel myocardial infarction, stent thrombosis, or stroke, with low-to-no heterogeneity across most endpoints. In ACS patients undergoing PCI, BP-DES and contemporary DP-DES demonstrate comparable long-term safety and efficacy across all major outcomes. The theoretical benefit of polymer biodegradability does not appear to translate into measurable clinical advantage, likely because modern biocompatible durable-polymer platforms have already addressed the inflammatory mechanisms BP-DES were designed to overcome. Both stent types remain suitable options for revascularization in this high-risk population, and larger, platform-specific trials with extended follow-up are warranted.

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