Boston Scientific (NYSE:BSX) outlined strong 2025 results and issued guidance for continued growth in 2026, highlighting broad-based performance across multiple business units, expanding operating margins, and an active pipeline of product initiatives and acquisitions.
Quarter and full-year financial results
Management said fourth-quarter consolidated revenue was $5.286 billion, representing 15.9% reported growth versus the prior-year period. Foreign exchange provided a 160 basis point tailwind in the quarter; excluding FX, operational revenue growth was 14.3%. The company said closed acquisitions contributed 160 basis points to Q4 sales, resulting in 12.7% organic revenue growth, which was at the high end of its guidance range.
For full-year 2025, Boston Scientific reported revenue of $20.074 billion, up 19.9% on a reported basis. Excluding an FX tailwind, operational growth was 19.2%. With acquisitions contributing 340 basis points, full-year organic revenue growth was 15.8%, above the company’s approximately 15.5% guidance.
Full-year adjusted EPS was $3.06, up 22% year over year and above the $3.02–$3.04 guidance range, marking the company’s “third consecutive year” of 20%+ adjusted EPS growth.
On margins, adjusted gross margin was 70.7% in Q4 and 70.6% for the year, a 30 basis point expansion versus 2024. Adjusted operating margin was 27.3% in Q4 and 28.0% for the year, an improvement of 100 basis points versus 2024. On a reported (GAAP) basis, Q4 operating margin was 15.6%, and full-year reported operating margin was 18.0%, which included a $194 million litigation charge related to the “full resolution” of a legacy IP matter.
Cash flow, balance sheet, and capital allocation
Boston Scientific reported free cash flow of $1.013 billion in the fourth quarter, and $3.659 billion for full-year 2025, which management said exceeded expectations and reflected 38% growth versus 2024 and 80% free cash flow conversion.
As of Dec. 31, 2025, the company had $1.965 billion in cash on hand and a gross debt leverage ratio of 1.9x. Management said that following the announcement of its agreement to acquire Penumbra, “all three major rating agencies” affirmed the company’s single-A-minus equivalent rating, and Fitch upgraded its outlook from stable to positive.
Leadership reiterated that its capital allocation priority remains strategic tuck-in M&A, followed by share repurchases. The company highlighted the close of the Nalu Medical acquisition (adding peripheral nerve stimulation to neuromodulation) and announced agreements to acquire Valencia Technologies (urology adjacency, expected to close in the first half of 2026) and Penumbra (cardiovascular adjacency including mechanical thrombectomy and neurovascular, expected to close in 2026).
2026 guidance and key assumptions
For 2026, the company guided to organic growth of 8.5%–10% for Q1 and 10%–11% for the full year. First-quarter reported revenue growth is expected to be 10.5%–12%, excluding an approximately 200 basis point FX tailwind based on current rates. For the full year, reported revenue growth is expected to be 10.5%–11.5%, excluding an approximate 50 basis point FX tailwind.
Management said the Q1 organic growth range includes an approximate 150 basis point impact from the discontinuation of Acclarent and a transient impact associated with the product removal of certain sizes of the Axios device. Executives also cited a “toughest comp of the year” dynamic in Q1, and said they expect growth to be higher in the second half once certain headwinds are annualized and the Axios devices return.
The company guided to Q1 adjusted EPS of $0.78–$0.80 and full-year adjusted EPS of $3.43–$3.49, representing 12%–14% growth versus 2025 and including an approximate $0.03 FX headwind. It also expects to expand adjusted operating margin by 50–75 basis points in 2026 and said adjusted gross margin should be roughly in line with 2025, as favorable mix is expected to be offset by supply chain investments and the annualization of tariffs.
Boston Scientific expects full-year 2026 free cash flow of approximately $4.2 billion and reiterated a long-range plan target of 70%–80% free cash flow conversion.
Business performance highlights and product updates
Regionally, management reported operational growth of 17% in the U.S. in Q4 and 26% for the full year, with strong performance cited in electrophysiology (EP), Watchman, and “ICTX.” EMEA grew 5% in Q4 and 3% for the year; management noted that excluding the Acclarent discontinuation impact, full-year growth would have been “high single digits.” Asia Pacific grew 15% operationally in Q4 and 14% for the year, led by mid-teens growth across Japan and China.
- EP: The company said global EP delivered 35% organic growth in Q4 and 73% growth for the full year. In Q&A, management argued the Q4 EP market was closer to 18%–20% growth (rather than 25% cited by some) and reiterated its expectation that the EP market will grow about 15% in 2026, with Boston Scientific expected to outpace it. Executives acknowledged anticipating some share loss as competitors launch, given the company’s strong position entering 2025, but said they expect to maintain clear market leadership in pulsed field ablation (PFA). The company also referenced recent approval and limited release of a Nav-enabled Farapulse catheter intended initially for atrial flutter, as well as trials including Rematch AF and an “optimized” trial studying mapping technology with Farapulse.
- Watchman: Management said Watchman grew 29% in Q4 and for the full year, with strong double-digit growth across major global markets and more than 25,000 concomitant patients treated. Executives said they have not seen an impact from CLOSURE-AF, AF, and Ocean trials. They also highlighted the Champion trial (Watchman Flex vs novel oral anticoagulation) as an ACC late breaker scheduled for Saturday, March 28, and said it includes co-primary endpoints for non-inferiority (stroke, systemic embolism, and death) and bleeding, with the bleeding endpoint powered for superiority.
- Endoscopy: Endoscopy posted 8% organic growth in Q4 and for the full year. Management said it initiated a product removal for certain sizes of the Axios device due to a manufacturing variation, expects to return devices to market “in full” by mid-year, and anticipates lower endoscopy growth in the first half as a result.
- Urology: Urology grew 13% operationally in Q4 and 23% operationally for the year, but management said performance was below expectations, citing supply chain issues and commercial disruption during integration. Executives said they expect the business to return to market growth in 2026 supported by new product launches and strengthening sacral neuromodulation.
- Cardiovascular: The cardiovascular segment grew 16% in Q4 and 21% organically for the full year. Interventional cardiology therapy sales grew 10% in Q4 and 8% for the year, with management highlighting Agent DCB and completion of enrollment in a fracture trial for the Seismic IVL system, with data expected later in 2026 and an expectation for the technology in the first half of 2027. The company also announced a reporting reorganization creating “Interventional Cardiology and Vascular Therapies.”
Management commentary on long-range targets
In response to investor questions, leadership reiterated confidence in its 2026–2028 goals, including 10%+ sales growth, 150 basis points of operating margin expansion, and leveraged double-digit EPS growth. Management said those targets were unchanged from its prior investor day and added that the Penumbra agreement could further strengthen the company once it closes.
About Boston Scientific (NYSE:BSX)
Boston Scientific Corporation (NYSE: BSX) is a global medical device company that develops, manufactures and markets a broad portfolio of products used in less-invasive medical procedures. Founded in 1979 by John Abele and Peter Nicholas, the company is headquartered in Marlborough, Massachusetts, and focuses on technologies that enable physicians to treat a wide range of cardiovascular, digestive, urologic, pulmonary and chronic pain conditions without open surgery.
Boston Scientific’s activities span product development, clinical research, regulatory affairs and commercial sales.
