Differences in long-term outcomes between drug-eluting stent platforms remain clinically relevant in patients undergoing percutaneous coronary intervention (PCI), particularly for mortality-related endpoints. A systematic review and meta-analysis presented at EuroPCR 2026 evaluated all-cause and cardiovascular mortality outcomes in patients treated with biolimus-eluting stents (BES) or sirolimus-eluting stents (SES) after PCI.

The analysis included randomized controlled trials and controlled comparative studies identified through PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials through June 30, 2025. Early-term (≤1 year) and mid-term (>1 to 5 years) mortality outcomes were assessed using random-effects models with pooled risk ratios and 95% confidence intervals. Statistical heterogeneity was evaluated using the I² statistic.

Findings

• Six randomized controlled trials involving 12,109 patients were included, with 6,088 assigned to BES and 6,021 assigned to SES.
• Within the first year after PCI, BES was associated with significantly lower cardiac mortality compared with SES (RR 0.70; 95% CI 0.52-0.93; P=0.015).
• BES also showed a non-significant trend toward lower all-cause mortality during early-term follow-up (RR 0.81; 95% CI 0.64-1.01; P=0.058).
• Mid-term analysis included 3 trials involving 6,111 patients, including 3,063 treated with BES and 3,048 treated with SES.
• Between 1 and 5 years of follow-up, no significant differences were observed between BES and SES for all-cause mortality (RR 1.09; 95% CI 0.93-1.28; P=0.283) or cardiac mortality (RR 1.09; 95% CI 0.85-1.40; P=0.495).
• Heterogeneity remained low across all evaluated outcomes (I²=0%).

The pooled analysis showed lower cardiac mortality with BES during the first year after PCI, while longer-term mortality outcomes were similar between BES and SES. Additional studies with extended follow-up may help clarify whether specific patient populations derive sustained benefit from BES.