OBJECTIVES: Patients with coronary artery disease (CAD) and type 2 diabetes (T2D) and no prior myocardial infarction (MI) or stroke remain at high risk of cardiovascular (CV) events (THEMIS outcome trial; NCT01991795). However, real-life data on outcome and costs among these patients are limited. The aim was to estimate the outcomes and costs for this population from a Swedish healthcare perspective. METHODS: Patients with CAD-T2D without prior MI or stroke were included from Swedish national registries, 2010-2015. Index was date of first elective percutaneous coronary intervention (PCI). A 30-day blanking period was applied post-index to capture non-PCI-related CV events (CV death/MI/stroke). Costs related to hospitalisations and outpatient care were based on diagnoses-related group (DRG) cost codes, while costs for pharmaceuticals were derived from national price lists. Mean annual CV-related and total costs (2018 €) were estimated for a follow-up period of three years post-PCI. RESULTS: A total of 2,265 patients with CAD-T2D with PCI and no prior MI or stroke were identified (mean age 67.3 years, 28.4% females). Three‐year cumulative incidence of CV death/MI/stroke was 11.7% (95% CI 10.3%-13.1%), with MI as the main risk driver. Total healthcare costs were greatest in the first year after PCI (€13,504/year) and remained high (€4,463-€4,744/year) for three years post-PCI. CV-related costs accounted for the largest part of total costs the first year after PCI (€9,812/year), and about one third of the total costs (€1,442-€1,662/year) in subsequent years. Hospitalizations were the main cost driver for CV-related and total costs. CONCLUSIONS: In this Swedish real-life setting, CAD-T2D patients with PCI and no prior MI or stroke infer a considerable cost to the healthcare system, especially in the first year post-PCI. The present data indicate that long-term ischemic risk prevention should be a key strategy in the management of CAD-T2D patients without prior MI requiring PCI.