The reduced long-term survival rate after CABG in patients with diabetes is likely due to a combination of more rapid progression of atherosclerosis, a lower long- term patency rate of SVGs,1173 and a greater burden of comorbid conditions. As in patients without diabetes, long- term outcome after CABG is better when an IMA is used as a conduit than when CABG is performed with only SVGs.362 A subgroup analysis of data from the BARI trial suggested that patients with diabetes who underwent CABG with 1 arterial conduit had improved survival compared with those who underwent PCI.516 Several subsequent observational and cohort studies also showed that CABG results in better long-term outcome in patients with diabetes and multivessel CAD compared with balloon angioplasty or BMS implanta- tion.361,451,1174 A meta-analysis of 10 RCTs comparing CABG with balloon angioplasty (n 6) or BMS implantation (n 4) concluded that the mortality rate was substantially lower in patients with diabetes undergoing CABG.451 Little information is available about CABG versus PCI with DES in patients with diabetes mellitus. 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. 