Background Data are limited regarding the influence of diabetes on the long-term outcomes of drug-eluting stents. Methods We compares the long-term outcomes of 865 diabetic patients to 3160 non-diabetic patients treated with DES. The primary endpoint was the composite of death, myocardial infarction (MI) or target vessel revascularization (TVR). The incidence of stent thrombosis was assessed by Academic Research Consortium criteria. Results Diabetic patients had a significant higher risk profile than non-diabetic patients (old age, a higher incidence of hypertension, renal failure, previous bypass surgery, complex lesions, multivessel disease, and longer stent length). After risk adjustment, there was no difference in the risk of death (adjusted hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.49-1.11) or MI (HR 1.06; 95% CI, 0.50-2.22) up to 3 years. However, there was a significant increase of TVR in diabetic patients (HR 2.34; 95% CI, 1.47-3.74; P<0.001). The primary end-point over 3 years was significantly higher in diabetic patients (HR 1.64; 95% CI, 1.27-2.11; P<0.001). The independent predictors of the composite endpoint was lower ejection fraction (P=0.015), renal failure (P=0.003), and diabetes (P<0.001). The incidence of stent thrombosis was similar between diabetic and non-diabetic patients (definite or probable; HR 0.85; 95% CI, 0.34-2.08). Conclusions Diabetic patients have a significant higher revascularization compared to non-diabetic patients without increases of death, MI, or stent thrombosis.