Objectives To evaluate the impact of biodegradable polymer drug-eluting stent (BP-DES) on the frequency of stent thrombosis (ST), target lesion revascularization (TLR), myocardial infarction (MI), and all-cause death in randomised controlled trials comparing the BP-DES with durable polymer drug-eluting stents (DP-DES).

Methods The following databases were searched, including PubMed, EMBASE, the Cochrane Library, Web of science. Two reviewers extracted data independently, according to methods of Cochrane Collaboration. Data analyses were performed with the Cochrane Collaboration’s RevMan 5.1 software.

Results Overall, 19,771 patients on 18 randomised trials were assigned to percutaneous coronary intervention with BP-DES (n = 10,907) versus DP-DES (n = 8864) during a weighted mean follow-up of 25.8 months. Compared with DP-DES, the BP-DES significantly reduced very late ST (0.3% vs 0.9%; odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.16 to 0.70, p for effect = 0.003; p for heterogeneity = 0.87), TLR (OR: 0.79; 95% CI: 0.63 to 0.99; p = 0.04). There was no significant difference between the groups in MI (OR: 1.08; 95% CI: 0.92 to 1.28; p = 0.36) and mortality (OR: 0.95; 95% CI: 0.81 to 1.12; p = 0.55). The treatment effect was consistent by different follow-up times and duration of dual antiplatelet therapy.

Conclusions Intracoronary implantation of the BP-DES is associated with highly significant reductions in very late ST with concordant reductions in long-term TLR compared to PP-DES. This suggests BP-DES facilitates re-endothelialisation after stent implantation, which in turn not only reduces the thrombogenity of DES but also potentially decreases neointimal hyperplasia. Large scale long-term clinical trials with adequate statistical power are needed to evaluate their clinical implication in the future.