The results of CARDia (Coronary Artery Revascularisation in Diabetes), the first RCT comparing CABG and PCI in a population consisting entirely of subjects with diabetes, suggested that PCI with DES (used in 69% of the PCI patients) and CABG achieved similar outcomes.475 Of the 1,800 subjects enrolled in the SYNTAX trial, which compared CABG and PCI with paclitaxel-eluting stents, 452 had medically treated diabe- tes.364 At 1-year follow-up, the 2 treatments exerted a similar effect on survival, MI, and the composite endpoint of death, MI, or stroke. As in the entire SYNTAX cohort, patients with diabetes randomly assigned to receive PCI had a higher rate of repeat revascularization (20.3% after PCI versus 6.4% after CABG; P 0.001), and those with highly complex lesions (ie, SYNTAX score 33) had a higher mortality rate with PCI (13.5% versus 4.1%; P 0.04). The FREEDOM (Future Revascularization Evaluation in patients with Diabe- tes mellitus: Optimal management of Multivessel disease) trial, an ongoing randomized comparison of CABG and PCI with DES in 1900 patients with diabetes and multivessel CAD, should shed further light on the preferred therapy for Few comparisons of CABG and contemporary medical therapy in patients with diabetes mellitus are of sufficient size to allow meaningful conclusions. The largest such trial, BARI 2D, randomly assigned 2368 patients with type 2 diabetes mellitus to revascularization plus intensive medical therapy or intensive medical therapy alone,404,1176 with patients in the medical therapy group to undergo revascularization during follow-up only if such therapy were clinically indicated by the progression of angina or the development of an ACS or severe ischemia. The planned method of revascularization, PCI or CABG, was determined before randomization by the treating physicians. No significant difference in primary endpoints was evident between the PCI group and the medical therapy group. 