Some evidence indicates that the presence of diabetes mellitus adversely affects the outcomes of revascularization. An analysis of the 2009 data on 7812 patients (1233 with diabetes mellitus) in 10 RCTs demonstrated a worse long- term survival rate in patients with diabetes mellitus after balloon angioplasty or BMS implantation than after CABG.1080 Analyses from 3 registries found significantly elevated adjusted ORs for short-term mortality after PCI that ranged from 1.25 to 1.54 in relation to patients without diabetes mellitus.1144,1146,1165 Data from the STS registry indicated that patients with diabetes mellitus on oral therapy had an adjusted OR of 1.15 for death within 30 days (95% CI: 1.09 to 1.21), as well as significantly higher odds of stroke, renal failure, or sternal wound infection than those of patients without diabetes mellitus.1167 For patients on insulin, the adjusted OR for death within 30 days was 1.50 (95% CI: 1.42 to 1.58), and the risks for other complications were also correspondingly higher. In summary, in subjects requiring revascularization for multivessel CAD, current evidence supports diabetes mellitus as an important factor to consider when deciding on a revascularization strategy, particularly when complex or ex- tensive CAD is present (Figure 14). The basis of the currently available data, an intensive approach to reducing cardiovascular risk and symptoms in patients with diabetes mellitus by using GDMT should be the initial approach. For patients whose symptoms are inade- quately managed or who experience intolerable adverse effects, revascularization should be considered. CABG might be associated with lower risk of mortality in patients with diabetes mellitus and multivessel disease than PCI, but this remains uncertain. 