Durable polymer DES (DP-DES) have been studied in a large number of patients and also in those with comorbidities like diabetes, high bleeding risk, etc., along with complex lesions like chronic total occlusion (CTO), left main, etc. Biodegradable polymer DES (BP-DES) have not demonstrated superiority to DP-DES. BP-DES still have to prove superiority in terms of safety and efficacy in complex lesions. BP-DES changes to BMS following drug-elution, and in clinical and pre-clinical trials, DP-DES have proven to be superior to BMS. BP-DES has still not shown superiority of safety and efficacy vs. current generation DP-DES in randomized clinical trials.

Researchers showed in ISAR-TEST (Intracoronary Stenting and Angiographic Results: Test Efficacy of 3 Limus-Eluting Stents) 4 that in head-to-head comparisons between three DES, biodegradable polymers did not make for better long-term outcomes. BP-DES have, at best, been shown to be noninferior to the durable-polymer standard. There seems to be no real late advantage to BP-DES.