---
title: "BIOFLOW-DAPT trial: biodegradable sirolimus vs durable zotarolimus stents in high-bleeding-risk ACS"
id: "pubmed-42555546"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42555546"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42555546/"
doi: "10.1093/ehjacc/zuag089"
published_at: "2026-08-29T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# BIOFLOW-DAPT trial: biodegradable sirolimus vs durable zotarolimus stents in high-bleeding-risk ACS
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42555546
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42555546/)
- **DOI:** [10.1093/ehjacc/zuag089](https://doi.org/10.1093%2Fehjacc%2Fzuag089)
- **Published At:** 2026-08-29T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The BIOFLOW-DAPT was a randomized controlled trial comparing **biodegradable polymer sirolimus-eluting stents** with **durable polymer zotarolimus-eluting stents** in patients with **acute coronary syndrome (ACS)** who were at **high bleeding risk**. - The article was published in Eur Heart J Acute Cardiovasc Care on 29 August 2026 (volume 15, issue 8, pages 596–607) and is listed as a free article. - The report lists a large, multinational authorship from multiple European centers and institutions, indicating a multicenter study. - The publication is indexed in PubMed (PMID 42555546) and has DOI 10.1093/ehjacc/zuag089. - The source page includes full author names and detailed affiliations across Germany, Austria, Poland, Hungary, Denmark, France, Italy, Switzerland, Belgium, and Egypt. - The PubMed record identifies the study type as a Randomized Controlled Trial. - The PubMed entry does not include the trial abstract text or key numerical results on endpoints, event rates, or statistical comparisons in the visible content provided here. Therefore, specific efficacy, safety, and bleeding outcomes, duration of dual antiplatelet therapy, sample size, randomization details, and follow-up were not reported in the SOURCE JINA body and cannot be restated. - Readers seeking trial outcomes, endpoint definitions, and detailed methods should consult the full text via the journal or the DOI link; those details were not available in the provided source content.
## Clinical Analysis & Structured Key Points
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* [ LinkOut - more resources ](https://pubmed.ncbi.nlm.nih.gov/42555546/#linkout) Title & authors Abstract Conflict of interest statement Similar articles Publication types MeSH terms Substances Associated data Related information LinkOut - more resources Randomized Controlled Trial Eur Heart J Acute Cardiovasc Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Acute+Cardiovasc+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Acute+Cardiovasc+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42555546/) . 2026 Aug 29;15(8):596-607. doi: 10.1093/ehjacc/zuag089. # Biodegradable polymer sirolimus-eluting or durable polymer zotarolimus-eluting stents in high bleeding-risk patients with acute coronary syndrome: the BIOFLOW-DAPT randomized trial [Nader Mankerious](https://pubmed.ncbi.nlm.nih.gov/?term=Mankerious+N&cauthor_id=42555546)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-1 "Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-2 "Cardiology Department, Zagazig University, Sharkia, Egypt."), [Rayyan Hemetsberger](https://pubmed.ncbi.nlm.nih.gov/?term=Hemetsberger+R&cauthor_id=42555546)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-3 "Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria."), [Adrian Wlodarczak](https://pubmed.ncbi.nlm.nih.gov/?term=Wlodarczak+A&cauthor_id=42555546)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-4 "Division of Cardiology, Copper Health Centre Inc., Lubin 59-301, Poland.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-5 "Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw 50-981, Poland."), [Béla Merkely](https://pubmed.ncbi.nlm.nih.gov/?term=Merkely+B&cauthor_id=42555546)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-6 "Heart and Vascular Center, Semmelweis University, Budapest, Hungary."), [Henning Kelbæk](https://pubmed.ncbi.nlm.nih.gov/?term=Kelb%C3%A6k+H&cauthor_id=42555546)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-7 "Department of Cardiology, Zealand University Hospital, Roskilde, Denmark."), [Guillaume Cayla](https://pubmed.ncbi.nlm.nih.gov/?term=Cayla+G&cauthor_id=42555546)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-8 "Department of Cardiology, University of Montpellier, Hospital of Nimes, Nîmes, France."), [Jacek Legutko](https://pubmed.ncbi.nlm.nih.gov/?term=Legutko+J&cauthor_id=42555546)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-9 "Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Krakow, Poland."), [Stefano Galli](https://pubmed.ncbi.nlm.nih.gov/?term=Galli+S&cauthor_id=42555546)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-10 "Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy."), [Matthieu Godin](https://pubmed.ncbi.nlm.nih.gov/?term=Godin+M&cauthor_id=42555546)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-11 "Department of Cardiology, Clinique Saint Hilaire, Rouen, France."), [Gabor G Toth](https://pubmed.ncbi.nlm.nih.gov/?term=Toth+GG&cauthor_id=42555546)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-12 "University Heart Center Graz, Medical University Graz, Graz, Austria."), [Thibault Lhermusier](https://pubmed.ncbi.nlm.nih.gov/?term=Lhermusier+T&cauthor_id=42555546)[ 13 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-13 "Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France."), [Mohammed Saad](https://pubmed.ncbi.nlm.nih.gov/?term=Saad+M&cauthor_id=42555546)[ 14 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-14 "Medical Faculty, Christian-Albrechts-University of Kiel, Kiel, Germany."), [Benjamin Honton](https://pubmed.ncbi.nlm.nih.gov/?term=Honton+B&cauthor_id=42555546)[ 15 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-15 "Cardiology Department, Clinique Pasteur, Toulouse 31300, France."), [Francesca Sanguineti](https://pubmed.ncbi.nlm.nih.gov/?term=Sanguineti+F&cauthor_id=42555546)[ 16 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-16 "Institut Cardiovasculaire Paris Sud, Ramsay Générale de Santé, Massy, France."), [Peter Laurenz Dietrich](https://pubmed.ncbi.nlm.nih.gov/?term=Dietrich+PL&cauthor_id=42555546)[ 17 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-17 "Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland."), [Derk Frank](https://pubmed.ncbi.nlm.nih.gov/?term=Frank+D&cauthor_id=42555546)[ 14 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-14 "Medical Faculty, Christian-Albrechts-University of Kiel, Kiel, Germany."), [Francis Stammen](https://pubmed.ncbi.nlm.nih.gov/?term=Stammen+F&cauthor_id=42555546)[ 18 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-18 "Department of Cardiology, AZ Delta, Roeselare, Belgium."), [Bert Ferdinande](https://pubmed.ncbi.nlm.nih.gov/?term=Ferdinande+B&cauthor_id=42555546)[ 19 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-19 "Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium."), [Johanne Silvain](https://pubmed.ncbi.nlm.nih.gov/?term=Silvain+J&cauthor_id=42555546)[ 20 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-20 "ACTION Group, Sorbonne Université, INSERM UMRS 1166, Hôpital Pitié-Salpêtrière \(AP-HP\), Institut de Cardiologie, Paris, France."), [Davide Capodanno](https://pubmed.ncbi.nlm.nih.gov/?term=Capodanno+D&cauthor_id=42555546)[ 21 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-21 "Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico 'G. Rodolico-San Marco,', University of Catania, Catania, Italy."), [Holger Nef](https://pubmed.ncbi.nlm.nih.gov/?term=Nef+H&cauthor_id=42555546)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-1 "Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany."), [Gert Richardt](https://pubmed.ncbi.nlm.nih.gov/?term=Richardt+G&cauthor_id=42555546)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-1 "Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany.")[ 22 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-22 "Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany."), [Ralph Toelg](https://pubmed.ncbi.nlm.nih.gov/?term=Toelg+R&cauthor_id=42555546)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-1 "Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany.")[ 14 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-14 "Medical Faculty, Christian-Albrechts-University of Kiel, Kiel, Germany.")[ 22 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-22 "Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany."), [Marco Valgimigli](https://pubmed.ncbi.nlm.nih.gov/?term=Valgimigli+M&cauthor_id=42555546)[ 23 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#full-view-affiliation-23 "Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale \(EOC\), Università della Svizzera Italiana, Via Tesserete 48, Lugano CH-6900, Switzerland.") Affiliations Expand ### Affiliations * 1 Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany. * 2 Cardiology Department, Zagazig University, Sharkia, Egypt. * 3 Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria. * 4 Division of Cardiology, Copper Health Centre Inc., Lubin 59-301, Poland. * 5 Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw 50-981, Poland. * 6 Heart and Vascular Center, Semmelweis University, Budapest, Hungary. * 7 Department of Cardiology, Zealand University Hospital, Roskilde, Denmark. * 8 Department of Cardiology, University of Montpellier, Hospital of Nimes, Nîmes, France. * 9 Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Krakow, Poland. * 10 Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy. * 11 Department of Cardiology, Clinique Saint Hilaire, Rouen, France. * 12 University Heart Center Graz, Medical University Graz, Graz, Austria. * 13 Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France. * 14 Medical Faculty, Christian-Albrechts-University of Kiel, Kiel, Germany. * 15 Cardiology Department, Clinique Pasteur, Toulouse 31300, France. * 16 Institut Cardiovasculaire Paris Sud, Ramsay Générale de Santé, Massy, France. * 17 Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland. * 18 Department of Cardiology, AZ Delta, Roeselare, Belgium. * 19 Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium. * 20 ACTION Group, Sorbonne Université, INSERM UMRS 1166, Hôpital Pitié-Salpêtrière (AP-HP), Institut de Cardiologie, Paris, France. * 21 Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico 'G. Rodolico-San Marco,', University of Catania, Catania, Italy. * 22 Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany. * 23 Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Università della Svizzera Italiana, Via Tesserete 48, Lugano CH-6900, Switzerland. * PMID: **42555546** * DOI: [ 10.1093/ehjacc/zuag089 ](https://doi.org/10.1093/ehjacc/zuag089) Free article Item in Clipboard Randomized Controlled Trial # Biodegradable polymer sirolimus-eluting or durable polymer zotarolimus-eluting stents in high bleeding-risk patients with acute coronary syndrome: the BIOFLOW-DAPT randomized trial Nader Mankerious et al. Eur Heart J Acute Cardiovasc Care. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Eur Heart J Acute Cardiovasc Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Acute+Cardiovasc+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Acute+Cardiovasc+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42555546/) . 2026 Aug 29;15(8):596-607. doi: 10.1093/ehjacc/zuag089. ### Authors [Nader Mankerious](https://pubmed.ncbi.nlm.nih.gov/?term=Mankerious+N&cauthor_id=42555546)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-1 "Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-2 "Cardiology Department, Zagazig University, Sharkia, Egypt."), [Rayyan Hemetsberger](https://pubmed.ncbi.nlm.nih.gov/?term=Hemetsberger+R&cauthor_id=42555546)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-3 "Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria."), [Adrian Wlodarczak](https://pubmed.ncbi.nlm.nih.gov/?term=Wlodarczak+A&cauthor_id=42555546)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-4 "Division of Cardiology, Copper Health Centre Inc., Lubin 59-301, Poland.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-5 "Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw 50-981, Poland."), [Béla Merkely](https://pubmed.ncbi.nlm.nih.gov/?term=Merkely+B&cauthor_id=42555546)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-6 "Heart and Vascular Center, Semmelweis University, Budapest, Hungary."), [Henning Kelbæk](https://pubmed.ncbi.nlm.nih.gov/?term=Kelb%C3%A6k+H&cauthor_id=42555546)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-7 "Department of Cardiology, Zealand University Hospital, Roskilde, Denmark."), [Guillaume Cayla](https://pubmed.ncbi.nlm.nih.gov/?term=Cayla+G&cauthor_id=42555546)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-8 "Department of Cardiology, University of Montpellier, Hospital of Nimes, Nîmes, France."), [Jacek Legutko](https://pubmed.ncbi.nlm.nih.gov/?term=Legutko+J&cauthor_id=42555546)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-9 "Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Krakow, Poland."), [Stefano Galli](https://pubmed.ncbi.nlm.nih.gov/?term=Galli+S&cauthor_id=42555546)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-10 "Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy."), [Matthieu Godin](https://pubmed.ncbi.nlm.nih.gov/?term=Godin+M&cauthor_id=42555546)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-11 "Department of Cardiology, Clinique Saint Hilaire, Rouen, France."), [Gabor G Toth](https://pubmed.ncbi.nlm.nih.gov/?term=Toth+GG&cauthor_id=42555546)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-12 "University Heart Center Graz, Medical University Graz, Graz, Austria."), [Thibault Lhermusier](https://pubmed.ncbi.nlm.nih.gov/?term=Lhermusier+T&cauthor_id=42555546)[ 13 ](https://pubmed.ncbi.nlm.nih.gov/42555546/#short-view-affiliation-13 "Department of Cardiology, Hôpit
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