BACKGROUND Several studies have compared the outcomes of two competing interventions for multivessel coronary artery disease: drug-eluting stents (DES) and coronary-artery bypass grafting (CABG). However, optimal revascularization treatment for patients with diabetes mellitus and multivessel coronary artery disease remains in dispute. METHODS Between January 2003 and December 2005, 891 diabetic patients with multivessel disease underwent DES implantation (n=489) or CABG (n=402). The primary safety outcomes were all-cause mortality and the composite risk of death, myocardial infarction (MI), or stroke, and the primary efficacy outcomes was the risk of repeat revascularization. The rates of adverse outcomes were adjusted by means of proportional-hazards methods to account for differences in patients��� severity of illness before revascularization. RESULTS During follow-up of median 5.4 years (interquartile, 4.7 to 6.0), the adjusted risks of mortality (hazard ratio, 1.36; 95% confidence interval [CI], 0.84 to 2.23; P=0.22) and the composite of death, MI, or stroke (HR, 1.44; 95% CI, 0.93-2.22, P=0.11) did not significantly differ between patients who received DES and those who underwent CABG. However, the rate of revascularization was significantly higher in the DES group than in the CABG group (HR, 3.96; 95% CI, 2.49-6.33, P<0.001). Similar findings were obtained both for diabetic patients with three-vessel disease and for diabetic patients with two-vessel disease. CONCLUSIONS For diabetic patients with multivessel disease, DES implantation showed similar 5-year rates of death and composite endpoint of death, MI, or stroke as do CABG. However, DES treatment was associated with higher rates of repeat revascularization than was CABG.