Coronary artery bypass graft (CABG) surgery is preferred over percutaneous coronary intervention (PCI) in patients with diabetes (DM) and multivessel disease (MVD). However, differences in survival are equivocal and outcomes according to sex remain unknown.

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. We examined death and death or myocardia infraction (MI) at 5-years. Cox proportional hazards model was used to examine the sex difference stratified by revascularization.

Among 4803 patients, 2941 underwent PCI (805 females [27%]; 2136 males [73%]) and 1862 underwent CABG (391 females [21%] and 1471 males [79%]). Regardless of type of revascularization females were older, had higher body mass index and comorbidity burden. Females versus males had higher rates of death and death/MI (PCI: F 4.2, M 3.0; CABG: F 4.8, M: 3.7 deaths per 100 person-year and PCI: F 6.2, M 4.7; CABG: F 5.9, M: 4.7 deaths per 100 person-year, p<0.01). However, no sex-difference was observed in adjusted survival (PCI: HR 1.15, 95% CI 0.90-1.46; CABG: HR 1.26, 95% CI 0.93-1.70) or death/MI outcomes (PCI: HR 1.14, 95% CI 0.94-1.40; CABG: HR 1.23, 95% CI 0.94-1.61).

Our study revealed that females versus male had higher risk of death or death/MI. However, these differences in outcomes were explained by differences in demographic and clinical characteristics. Our results could be considered when contemplating revascularization strategy based on survival.