Coronary artery bypass graft (CABG) surgery is preferred over percutaneous coronary intervention (PCI) in patients with diabetes (DM) and multivessel disease (MVD). However, it is unclear whether CABG confers a survival advantage.

Patients with DM and MVD undergoing either PCI (with drug-eluting stents) or CABG within 90-days of cardiac catheterization between 01/05/2009-03/29/2019 in Alberta, Canada were included. The study excluded patients with previous revascularization or other cardiac interventions. We examined death and death or myocardial infarction (MI) 5-years post revascularization via linkage with vital statistics death registry and hospitalization data. Inverse probability of treatment weighting was used to balance baseline characteristics between PCI and CABG groups and then compared the survival difference with Cox proportional hazards model.

Among 4803 patients, 2941 (61.2%) had PCI and 1862 (38.8%) had CABG. PCI recipients were more likely to be female, younger, to have higher body mass index, present with ST-elevation MI or lesser extent of MVD than CABG patients. At 5-years there was no significant difference in the death rate or the death/MI rate between two groups (Death, PCI: 3.2, CABG 3.6 events per 100 person-year, p=0.16) and (Death/MI PCI: 5.1, CABG 4.7 events per 100 person-year, p=0.35). Adjusting for confounding factors did not change the associations of PCI vs CABG (Death HR: 0.96, 95% CI 0.73, 1.24) and (Death/MI HR: 1.16 95% CI 0.92, 1.45).

No significant difference in all-cause death or death/MI was found between revascularization strategies, providing guidance on selection for patients with DM and MVD.