Clinical performance of Magmaris bioresorbable scaffold and modern drug-eluting stents (Biomatrix, Ultimaster, Orsiro) in coronary artery disease: a systematic review and meta-analysis

Background: Coronary artery disease (CAD) remains a major cause of morbidity and mortality despite advances in percutaneous coronary intervention (PCI). Although contemporary drug-eluting stents (DESs) have improved outcomes, their permanent metallic structure may contribute to late adverse events. The Magmaris bioresorbable magnesium scaffold (BRS) provides temporary vessel support with gradual resorption, potentially overcoming limitations of permanent implants. Methods: A systematic review and meta-analysis was conducted to evaluate the safety and efficacy of Magmaris BRS compared with contemporary DES platforms, including Biomatrix, Ultimaster, and Orsiro, in patients undergoing PCI for de novo CAD. PubMed, Scopus, and ScienceDirect were searched through 1 March 2026. Eligible studies included prospective trials, registries, and cohort studies reporting outcomes such as target lesion failure (TLF), scaffold/stent thrombosis, myocardial infarction (MI), and target vessel revascularisation with at least 6 months of follow-up. Pooled estimates were calculated using a DerSimonian–Laird random-effects model, with subgroup analyses based on clinical and demographic characteristics. Results: Thirty-six studies involving more than 25,000 patients were included. Magmaris BRS demonstrated low rates of all-cause mortality (1%), thrombosis (1%), and MI (2%), comparable to contemporary DES. However, TLF and target lesion revascularisation increased over time, rising from approximately 2% at 1 year to 6% at 2 years, suggesting possible vulnerability during scaffold resorption. Heterogeneity was low for safety outcomes and moderate to high for efficacy endpoints. Conclusions: Magmaris BRS shows acceptable medium-term safety and efficacy comparable to modern DES, supporting its use in selected patients. Nevertheless, longer-term randomised studies are needed to clarify outcomes beyond scaffold resorption and optimise patient selection.