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Call sheet · Q4'25

Boston Scientific (BSX)

Q4'25 earnings call · held February 4, 2026 · compared with the Q3'25 call · management-credibility review
8/12
Disclosure score
2 medium, 4 low flags
Financial quality
Bottom line
The sleeper story everyone's missing is complex coronary's 31% Q4 growth, quietly transforming ICTX into a diversified growth engine beyond just Agent DCB, setting up a massive catalyst with IVL coronary launching in early 2027. Yes, EP growth 'disappointed' at 35% versus Street hopes for 25% market growth, but BSX crushed real competitors growing 6.5% and 12.5%, and management's confident they'll be 'clear market leader by year-end 2026.' The binding constraint isn't demand or competition - it's capacity, with ASCs still building out and hospitals managing procedure backlogs. Management said 'We think there'll be a minimal impact on ASC in '26... it will take some time to build out the ASC capabilities.' The most revealing quote: when asked about EP share losses, Mahoney pivoted to market size rather than defending share, suggesting they're managing expectations downward. My view changes if Q1 EP growth comes in below the 8.5-10% guide or if complex coronary momentum stalls.

The 30-second version

  • Complex coronary quietly becoming the real growth engine while everyone obsesses over EP share losses
  • EP 'disappointment' is actually market normalization with BSX still gaining share vs real competitors
  • Axios device withdrawal creates a stealth margin tailwind that nobody's modeling

What changed this quarter

MetricQ3'25Q4'25Change
Total Revenue$4.58B (15.3% YoY)$5.29B (15.9% YoY)+50 bps acceleration despite tough comps
Organic Growth15.3%12.7%-260 bps deceleration but beat high-end guidance
Adjusted EPS$0.75 (19% YoY)$0.80 (15% YoY)-400 bps deceleration but beat by $0.01-$0.03
EP Revenue Growth63%35%-2,800 bps deceleration (massive but expected)
WATCHMAN Growth35%29%-600 bps deceleration, anniversaring concomitant
Complex Coronary GrowthNot disclosed31% Q4, 23% FYNew disclosure shows hidden strength
ICTX Revenue GrowthNot disclosed Q410% despite ACURATE lossStrong underlying performance
Free Cash Flow$1.16B$1.13B-$30M sequential decline
Operating Margin28.0%27.3%-70 bps sequential compression
China GrowthMid-teensDouble-digitLanguage softened from specific to generic

Accountability tracked

8 new promises made4 narrative shifts flagged7 prior promises scored
Inside the full report
The complete write-up covers the full promise ledger with kept/missed calls, disclosure-quality scoring, the metrics-vanished check, verification items, and the questions to ask next quarter.
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Scores, kept-promise rates, and flags on this site reflect the author's opinion, applying a stated methodology to statements management made on public earnings calls. Informational and educational purposes only - not investment advice, a recommendation, or an offer to buy or sell any security. Sources believed reliable but not guaranteed; the author may hold positions in the securities discussed.

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