(1) Background: The initial phase of this prospective systematic literature review (SLR) showed that short-term 1-year outcomes with non-drug-eluting titanium-nitride-oxide-coated stents (TiNOS) in acute coronary syndrome (ACS) are non-inferior to drug-eluting stents (DES) in terms of device-oriented composite Major Adverse Cardiac Events (MACE) and safer than DES in terms of recurrent myocardial infarction (MI). This second phase of the SLR assesses long-term 5-year outcomes. (2) Methods: The SLR protocol (PROSPERO CRD4201809062) was conducted per PRISMA guidelines. Prospective, randomized, controlled trials (RCTs) comparing MACE and its components after 5-year follow-up post-PCI with TiNOS vs. DES were searched. Each endpoint's pooled risk ratio (RR) was computed and stratified in RCTs with ACS only vs. RCTs with chronic coronary syndrome (CCS) or ACS. (3) Results: Four RCTs were eligible, comprising 1,772 patients with TiNOS vs. 1,273 with DES. Three RCTs reported outcomes in ACS only (1,630 vs. 1,123 pa-tients). Pooled RRs in the ACS-only RCTs were: MACE 0.82 [0.68, 0.99], MI 0.58 [0.44, 0.78], cardiac death (CD) 0.46 [0.28, 0.76], ischemia-driven target lesion revascularization (TLR) 1.03 [0.79, 1.33], probable or definite stent thrombosis (ST) 0.32 [0.21, 0.59], and total death (TD) 0.84 [0.63, 1.12]. Evidence certainty was high and robust to sensitivity analysis in MACE, MI, and ST, moderate and not robust in CD, TLR, and TD. The clinical validation and generalization would require stratifying the pooled RRs by clinical presentation. (4) Conclusions: TiNOS efficacy appears safer than DES in CD, MI, and ST and is similarly efficacious in TLR, and MACE, with a similar TD rate, in ACS at 5-year follow-up.