A Comparison of Performance of the Different Generations of Magnesium-Based Bioresorbable Coronary Stents

Background: The permanence of contemporary coronary stents is associated with chronic complications, particularly in-stent restenosis and stent thrombosis. Poly-L-lactic-acid-based bioresorbable stents were withdrawn given late stent thrombosis risk. Magnesium-based bioresorbable stents (MgBRS) have emerged as promising alternatives. This study documents the safety and efficacy profile of MgBRS generations. Methods: A systematic review was performed using EMBASE, MEDLINE and Web of Science (2007 to August 2025). Studies include individuals requiring percutaneous coronary intervention for coronary artery disease with MgBRS. Primary outcomes were cardiac death, definite/probable scaffold thrombosis and target vessel failure (TVF), organised into ≤12, ≤24, ≤36 and ≤60 months. The secondary outcome was late lumen loss (LLL). Results: Four MgBRS generations were identified: AMS-1, DREAMS 1G, Magmaris and Freesolve; and 25 studies were included. Cardiac death and stent thrombosis rates were under 1.0% up to 24 months for all, and 0% with Freesolve at 36 months. AMS-1 had the highest TVF rate at 44.4% at 12 months, improving to 3.6% at 36 months in Freesolve. Only Magmaris had 60-month data, showing 3.4% cardiac death, 2.7% stent thrombosis and 16.4% TVF rates. The data suggest improvement in 12-month LLL: DREAMS 1G (0.4 ± 0.3 mm), Magmaris (0.5 ± 1.1 mm) and Freesolve (0.2 ± 0.4 mm). Conclusions: Each successive generation demonstrated improvement in all studied outcomes since the underperformance of AMS-1. The favourable performance of Freesolve is comparable to contemporary drug-eluting stents. Results of randomised head-to-head trials are anticipated.