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Objective To evaluate the safety and efficacy of drug-eluting stents (DES) implantation in diabetic patients with multivessel coronary artery disease (MVD) compared with coronary artery bypass graft (CABG) on the clinical outcomes. Methods From May 2003 to April 2005, 150 consecutive type 2 diabetic patients with MVD underwent revascularization, 84 by percutaneous coronary intervention (PCI) with DES and 66 by CABG. The study end point was the incidence of major adverse cardiovascular events (MACEs) during hospital interval after procedure and follow-up. Results Most preoperative characteristics were similar in two groups, but left main disease (30% vs 4% , P=0.001) and three-vessel disease (70% vs 54%, P=0.045) were mare prevalent in CABG group. Complete revascularization was achieved in more patients in CABG group than that in PCI group (82% vs 67%, P=0.037). Cumulative incidence of MACEs in hospital was similar between two groups (2.4% PCI vs 9.1% CABG, P=0.069) despite the higher early morbidity (6.1% vs 0%, P=0.022) associated with CABG. Patients were followed up clinically for a mean of 18 ± 8 months ( range 13-36 months). The incidence of MACEs remained higher after PCI with multiple DES (21.4 % vs 9.1%, P=0.041) mainly driven by a mare require for repeat revascularization (13.1% vs 3.0%, P=0.030 ). Conclusion PCI with DES implantation, combined with tight glycemic control, aggressive cardiovascular risk factor modification and antiplatelet treatment, may be a safe and feasible alternative to CABG for selected diabetic patients with multivessel disease.