The benefit of CABG was related to differences in rates of both MI (P<0.001) and death from any cause (P=0.049). Stroke was more frequent in the CABG group, with 5-year rates of 5.2% in the CABG group and 2.4% in the DES group (P=0.03). Other studies have provided mixed evidence, but none has suggested a survival advantage of PCI. The 5-year update from the SYNTAX trial did not show a significant advantage in survival after CABG compared with survival after DES in patients with diabetes mellitus and multivessel CAD (12.9% A meta-analysis of 4 trials showed no significant advantage in survival after CABG compared with survival after PCI for patients with diabetes mellitus In a pooled analysis, it was found that patients with diabetes mellitus assigned to CABG had improved survival (23% versus 29%; P=0.008 for the interaction between presence of diabetes mellitus and type of revascularization procedure after adjustment).93 The strongest evidence supporting the use of CABG over PCI for patients with diabetes mellitus and multivessel CAD comes from a published meta-analysis of 8 trials (including The study of 3131 patients showed that at 5-year or longest follow-up, patients with diabetes mellitus randomized to CABG had a lower all-cause mortality rate than did those randomized to PCI with either DES or bare metal In summary, patients with SIHD and diabetes mellitus should receive GDMT. For patients whose symptoms compromise their quality of life, revascularization should be considered. CABG appears to be associated with lower risk of mortality than is PCI in most patients with diabetes mellitus and complex Fihn et al 2014 Stable Ischemic Heart Disease Focused Update 1759 multivessel disease, although the Heart Team may identify exceptions. 