Background: Although historically coronary artery bypass grafting (CABG) has been the treatment of choice for management of multivessel coronary artery disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is increasingly being preferred. The aim of this study was to compare the outcomes of PCI with DES implantation and CABG for treating multivessel disease in metabolic syndrome patients with acute myocardial infarction (AMI). Methods: We selected 1,839 consecutive metabolic syndrome patients with AMI who underwent PCI with DES implantation (n=1715) and CABG (n=124) for the treatment of multivessel disease from Korea Acute Myocardial Infarction Registry from Nov. 2005 through Dec. 2006. The primary endpoint was 12-month all-cause mortality. Results: Mean age was 64.9짹11.6 years and 64.3% were men. The rate of mortality at 12-month was significantly lower in PCI-DES group (4.8% versus 12.2% in CABG, p=0.014) in uni-variate analysis. However, after statistical adjustment for multiple confounders in Cox model, 12-month mortality was similar between the 2 groups (p=0.603) which remained same despite propensity score adjustment using Cox model (p=0.485). At 12 months, the rate of repeat revascularization was significantly higher in PCI-DES group compared to CABG group in this cohort (p<0.001). Conclusions: PCI with DES implantation showed equivalent 12-month mortality risk as CABG for the treatment of multivessel disease in metabolic syndrome patients with AMI.