BACKGROUND Limited information is available on long-term outcomes for patients with multivessel coronary artery disease who underwent drug-eluting stents (DES) or coronary-artery bypass grafting (CABG). METHODS We evaluated 3,042 patients with multivessel disease who received DES (n=1,547) or underwent CABG (n=1,495) between January 2003 and December 2005 and for whom complete follow-up data were available for median 5.6 years (interquartile range, 4.6-6.3 years). We compared adverse outcomes (death; a composite outcome of death, myocardial infarction [MI], or stroke; and repeat revascularization). RESULTS After adjustment for differences in baseline risk factors, 5-year risk of death (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.76-1.32, P=0.99) and the combined risk of death, MI, or stroke (HR, 0.97; 95% CI, 0.76-1.24, P=0.81) were similar between the two groups. However, the rates of revascularization were significantly higher in the DES group (HR, 2.93; 95% CI, 2.20 to 3.90, P<0.001). Similar results were obtained in comparison of DES with CABG for high-risk clinical and anatomical subgroups with diabetes, abnormal ventricular function, age >65 years or older, and three-vessel disease. However, mortality benefit with DES implantation relative to CABG was noted in patients with two-vessel disease (HR, 0.57; 95% CI, 0.36-0.92, P=0.02). CONCLUSIONS For patients with multivessel disease, DES treatment, compared to CABG, showed similar rates of mortality and of the composite safety outcomes, but higher rates of revascularization up to 5 years. Key words: coronary disease, revascularization, stents, surgery