tapebrief
BSX · Q3 2025
BSX · Q1 2026

BSX · Q4 2025 Earnings

Bullish

Boston Scientific

Reported February 4, 2026

30-second summary

30-second take: Boston Scientific closed Q4 with $5.29B revenue (+15.9% YoY reported, 12.7% organic) and adjusted EPS of $0.80, beating the high end of every Q4 guide and producing FY2025 adjusted EPS of $3.06 versus a prior $3.02–$3.04 range. The 2026 setup is the news: reported revenue guidance of +10.5–11.5% steps growth down roughly 9 points from FY2025's 19.9%, with ~150bps of that drag explicitly tied to Acurate discontinuation and the Axios partial product removal — and management announced the Penumbra acquisition to fill the mechanical thrombectomy and neurovascular gap. EP grew 35% in Q4 (exiting at ~65% PFA share), Watchman grew 29%, and management telegraphed Champion trial upside that would expand the indicated Watchman population from ~5M to ~20M patients globally.

Headline numbers

EPS

Q4 FY2025

$0.80

Revenue

Q4 FY2025

$5.29B

+15.9% YoY

Gross margin

Q4 FY2025

69.6%

Operating margin

Q4 FY2025

15.6%

Key financials

Q4 FY2025
MetricQ4 FY2025YoYQ3 FY2025QoQ
Revenue$5.29B+15.9%$5.07B+4.4%
EPS$0.80—$0.75+6.7%
Gross margin69.6%—69.9%-30bps
Operating margin15.6%—20.7%-510bps

Guidance

Guidance is issued for the full year only, refreshed each quarter. Prior and new below are the same FY updated this quarter.

Actuals vs prior guidance

MetricPeriodPrior guideActualΔResult
Adjusted EPSQ4 FY2025$0.77 to $0.790.8+0.01 above guideBeat
Revenue growth (reported basis)Q4 FY202514.5% to 16.5%15.9%+0–1.4pts above guideBeat
Revenue growth (organic basis)Q4 FY202511% to 13%12.7%+0–1.7pts above guideBeat
Revenue growth (reported basis)FY2025approximately 20%19.9%-0.1pts below guideBeat
Revenue growth (organic basis)FY2025approximately 15.5%15.8%+0.3pts above guideBeat

New guidance

MetricPeriodGuideYoY
Adjusted EPSQ1 FY2026$0.78 to $0.80—
Revenue growth (reported basis)Q1 FY202610.5% to 12.0%10.5% to 12.0%
Revenue growth (organic basis)Q1 FY20268.5% to 10.0%8.5% to 10.0%
Adjusted EPSFY2026$3.43 to $3.49—
Revenue growth (reported basis)FY202610.5% to 11.5%10.5% to 11.5%
Revenue growth (organic basis)FY202610.0% to 11.0%10.0% to 11.0%

Changes to prior guidance

MetricPeriodPrior guideNew guideΔResult
Adjusted EPS
FY2025
$3.02 to $3.043.06+$0.02 to +$0.04Raised

Segment KPIs

Q4 FY2025
SegmentQ4 FY2025YoY
Cardiovascular$3.477B+18.2%
MedSurg$1.809B+11.7%
Endoscopy$0.76B+10.1%
Urology$0.717B+13.8%
Neuromodulation$0.332B+11.1%
Cardiovascular organic growth16.1%—
MedSurg organic growth6.5%—

Other KPIs

Q4 FY2025
SegmentQ4 FY2025YoY
United States$3.385B+17.0%
Europe, Middle East and Africa$0.933B+12.4%
Asia-Pacific$0.788B+15.2%
Operational net sales growth (Q4)14.3%—
Organic net sales growth (Q4)12.7%—
Full-year operational growth19.2%—
Full-year organic growth15.8%—
U.S. operational growth17.0%—
EMEA operational growth4.8%—

Management tone

Narrative arc: Q1 ASC tailwind framing → Q2 ASC walk-back and tariff sizing → Q3 margin commitment and tariff-absorbed execution → Q4 portfolio-gap-filling and Champion-as-paradigm-shift.

The most consequential tonal shift this quarter is on Watchman's framing. Two quarters ago Watchman was discussed as a strong but ASC-constrained franchise with structural attach-rate dilution risk; last quarter it was framed as the engine carrying Cardiology at +35%; this quarter management explicitly elevated it to a category-redefining platform, anchoring on the Champion trial: "this data would support Watchman as a first-line therapy for stroke prevention as an alternative to OAC and would expand the number of indicated patients from approximately 5 million today to 20 million globally." The 4x TAM claim is the most aggressive forward statement management has made on any product in the four quarters covered. It signals confidence that the OPTION-driven concomitant ramp is no longer the ceiling — Champion is.

The EP narrative similarly hardened. Three quarters ago EP was framed as an emerging growth driver with FarraPoint and FarraFlex as the second-gen roadmap; last quarter it was the Q3 organic growth contributor; this quarter management explicitly claims market dominance with "approximately 70% of AF ablations in the U.S. in 25 were done with PFA" and an exit share of ~65%. Importantly, in Q&A management volunteered a recalibration of the underlying market: the Street's 25% market growth assumption is too high — Q4 market growth was 18-20%, and 2026 will be ~15%. That is a meaningful Street-consensus contradiction, and management chose to deliver it on the print rather than let it surface through model revisions.

The portfolio-gap conversation also changed character. Through 2025 BSX's M&A was framed as opportunistic tuck-ins (NALU, Cortex, Bayless). This quarter it became an explicit acknowledgment of structural holes: "Penumbra offers a highly differentiated portfolio that operates in high growth segments where Boston Scientific lacks offerings, including mechanical thrombectomy and neurovascular." That is unusually direct language for a CEO discussing competitive positioning. The shift from "we are adding capabilities" to "we lack offerings" is the kind of admission that usually precedes a more ambitious inorganic chapter.

The 2026 guide itself is the cleanest tonal tell. Reported growth steps down from FY2025's 19.9% to 10.5–11.5% — a roughly 9-point deceleration. Management framed this constructively (150bps of drag from Acurate and Axios reversing by June 2026; concomitant procedures driving operational efficiency; Penumbra closing as upside) rather than defensively. CFO held to "we expect to expand adjusted operating margin by 50 to 75 basis points" — slightly higher than the "~50bps every year" cadence committed to last quarter, suggesting management is not flinching on margin even as growth normalizes.

What did NOT come up: the ASC migration narrative that dominated Q2 prepared remarks has now been absent for two consecutive quarters. Either the topic is settled in management's view or it has been intentionally de-emphasized.

Recurring themes management leaned on this quarter:

PFA technology market penetration and ecosystem leadershipWatchman first-line therapy potential and patient population expansionEP and Watchman concomitant procedure adoption driving operational efficiencyStrategic M&A filling portfolio gaps (Penumbra, Valencia)Supply chain normalization enabling growth restorationMargin expansion trajectory progressing toward long-range targets

Risks management surfaced:

Endoscopy product removal reducing growth in first half of 2026Axios device manufacturing variation requiring mid-year return to marketAccurate discontinuation headwind in EMEA full-year guidanceForeign exchange headwind of approximately 3 cents in 2026 EPSPenumbra and Valencia acquisitions subject to customary closing conditions and regulatory approval

Q&A highlights

Robbie Marcus · JP Morgan

Asked why USEP was flat Q3 and US Watchmen missed expectations, given these are key growth drivers. Questioned whether Street consensus of 25% EP market growth needs to be lowered and sought clarity on 2026 guidance.

Management stated EP grew 35% in Q4 (vs competitors at 6.5-12.5%), with Q4 exceeding internal targets. Attributed market growth to ~18-20% (not 25%), claimed continued share gains, and reiterated confidence in 15% market growth and above-market company growth in 2026. Watchmen grew 29% in Q4.

EP growth 35% in Q4 vs competitor range 6.5-12.5%Q4 market growth estimated 18-20%, not 25%Watchmen growth 29% in Q42026 market growth guidance ~15%

Travis Steed · Bank of America

Questioned why USEP was flat sequentially when RF competitors grew 18-26M sequentially in US. Asked if share loss occurred despite bullish December investor meetings and sought explanation for Q1 8.5-10% guidance.

Management acknowledged anticipated share loss due to high market share position and competitive launches. Explained Q1 guidance impacted by toughest comp of year and ~150 bps drag from Acura discontinuation and Axios partial withdrawal. Reiterated full-year 10-11% guidance and expectation of faster-than-15% EP growth for 2026.

Expected and planned for share loss given dominant market positionQ1 2026 growth 8.5-10% vs full-year 10-11%150 bps headwind from Acura discontinuation and Axios partial withdrawal in H1 2026Impact of product discontinuations expected to reverse by June 2026

Rick Wise · Stifel

Asked for 2026 EP cadence outlook, growth acceleration drivers from innovation pipeline, implications of Fairpoint launch, ancillary products (ice catheter, etc.), and Ferroflex timing to understand sequential progression and setup for 2027.

Management outlined 65% PFA market share exit position with 15% market growth. Highlighted geographic expansion (Japan, China, Europe), new Fairpoint approval, expanded mapping infrastructure, and pipeline products. Stated pipeline products won't meaningfully impact 2026 but will support long-term growth and market leadership maintenance.

Exiting 2025 at ~65% PFA market shareFairpoint catheter approval in Europe and USU.S. PFA penetration at 70-80%International penetration significantly lower, expansion opportunity

Danielle Antalfi · UBS

Asked about EP lab capacity constraints given efficiency gains from Farapulse are likely largely captured, and how lab capacity limitations and growing wait lists might impact market growth and Champion trial opportunity.

Dr. Stein confirmed efficiency gains from Farapulse are now built into baseline after 3 years. Identified capacity constraints as limiting market growth to ~15% vs higher potential. Noted ASC buildout, cath lab repurposing, concomitant procedure growth, and Siemens partnership as capacity solutions.

Farapulse efficiency gains largely captured after 3 years of useGrowing EP lab wait lists constraining market growth to ~15%15% market growth reflects capacity limitations, not demand constraintsASC buildout and cath lab repurposing needed to unlock additional capacity

Matt Taylor · Jefferies

Asked about Champion trial outcome expectations—specifically whether superiority is possible on any endpoints or secondaries, and whether a positive Champion could boost concomitant adoption in the option patient population.

Management clarified bleeding endpoint is powered for superiority (goal to show Watchman superiority on bleeding complications), while stroke endpoint powered only for non-inferiority. Confirmed positive Champion would strengthen current indication referrals and concomitant adoption, plus unlock new indication with potential for sustained multi-year growth.

Champion bleeding endpoint powered for superiority (like option trial showed)Stroke endpoint powered for non-inferiority onlyPositive Champion expected to strengthen current AFib indication referralsNew indication expansion will require time, guideline updates, CMS coverage review

Answers to last quarter's watch list

EMEA inflection or share-loss confirmation — Mixed. EMEA reported growth jumped to +12.4% from +2.6%, but operational growth was only +4.8% — the headline acceleration is largely FX. Underlying weakness has not resolved, and management cited Acurate discontinuation as a continued EMEA-specific FY2026 headwind.
Continue monitoring
Krakrod back-order resolution — Resolved positively. Q4 organic growth of 12.7% landed near the high end of the 11–13% guide, implying clean ERP recovery as management indicated. No further commentary suggested lingering issues.
Resolved positively
2026 tariff annualization quantification — Not resolved. Management did not size 2026 tariff annualization on this print; the only quantified 2026 EPS headwind disclosed was ~3 cents of FX. The FY2026 50–75bps margin expansion guide implicitly absorbs whatever tariff annualization exists, but the explicit number is still owed.
Not resolved
Watchman growth durability — Resolved positively. Watchman grew 29% in Q4 (versus +35% in Q3), normalizing modestly but sustaining well above the +15–20% threshold flagged last quarter. Management's Champion-driven framing further extended the durability narrative.
Resolved positively
Neuromodulation post-NALU print — Resolved negatively (for the bull thesis). Neuromod reported growth lifted to +11.1% from +9.1%, but did not reach the mid-teens threshold that would validate the 2026 acceleration narrative. NALU's first quarter of contribution did not produce the inflection management implied.
Resolved negatively
CRM dollar-vs-unit gap — Continue monitoring. Management did not provide explicit Q4 commentary on CRM dollars-vs-units or leadless ASP stabilization ahead of the Denali H2 2026 launch. The topic was not called out on this print.
Continue monitoring

What to watch into next quarter

Q1 2026 organic growth landing point — Management guided 8.5–10% organic for Q1 with ~150bps of explicit Acurate/Axios drag. A print below 8.5% would imply the discontinuation impact is worse than sized or EP share loss is accelerating; a print at the high end would validate the H1 trough narrative.

Penumbra and Valencia closing milestones — Both deals are expected to close in H1 2026 subject to regulatory approval. Watch for any delay or scope modification, which would force a guidance revision since FY2026 currently excludes both.

EP share trajectory and Fairpoint contribution — Management explicitly guided to share compression from ~65% as competitive launches land. Watch whether Q1 EP organic growth sustains above the 15% market growth rate, which is the threshold for the "above-market" claim to hold.

2026 tariff annualization disclosure — Owed from last quarter, deferred again this quarter. Expect Investor Day or the Q1 print to put a number on it; anything materially above the FY2025 $100M impact compresses the 50–75bps margin expansion guide.

EMEA operational growth direction — Q4 operational EMEA at +4.8% is now a third consecutive sub-5% operational quarter when stripping out FX. Watch whether Q1 operational EMEA inflects above 5% as Acurate annualizes, or extends the structural weakness into a fourth quarter.

Champion trial readout signaling — Management has framed Champion as a 4x TAM event for Watchman. Watch for any pre-readout commentary on enrollment completion or interim safety signals; management may guide more specifically on timing at Investor Day.

Sources

  1. Boston Scientific Q4 2025 Earnings Release (SEC EDGAR): https://www.sec.gov/Archives/edgar/data/885725/000088572526000006/q42025earningsrelease.htm
  2. Q4 2025 earnings call Q&A (JP Morgan, Bank of America, Stifel, UBS, Jefferies exchanges)
  3. Boston Scientific Q3 2025 and Q2 2025 earnings briefs (Tapebrief, internal — prior quarter references for tone arc and watch-list resolution)

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