OBJECTIVES: Diabetes patients with coronary artery disease represent a population with high cardiovascular morbidity and mortality. The objective of the study was to compare the long-term effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in diabetic patients with multi-vascular coronary artery disease (MVD). METHODS: Studies were retrieved from PUBMED database using keywords: angioplasty, coronary, stent, PCI and coronary artery bypass surgery (August 1992 to December 2009).  Randomised controlled trials which compared PCI and CABG in head to head comparisons were included according to pre-specified inclusion/exclusion criteria. The outcomes of interest were mortality, myocardial infarction (MI), stroke, and the use of additional revascularization procedures. Two reviewers independently extracted data from the included studies. Data was analyzed using STATA (v9.0).RESULTS: Of the 416 studies identified, 5 studies met the inclusion criteria. A total of 813 patients were included in this analysis (208 in ARTS, 78 in EARCI-II, 115 in MASS-II, 353 in BARI trial, and 59 in EAST). In total, 409 diabetic patients with MVD were randomized to PCI, and 404 were randomized to CABG. Survival was significantly greater after CABG than after PCI with a risk ratio of 1.28 (95% CI 1.06, 1.55); p = 0.009 for the five-year mortality rate. The relative risk for revascularization rate at five year follow-up was 4.11 (95% CI: 2.20, 7.68) for PCI vs. CABG. Results for myocardial infarction were non-significant with a risk ratio of 1.10 (95% CI: 0.73, 1.65); p = 0.644. CONCLUSIONS: CABG was associated with lower incidence of mortality and revascularization at five years of follow-up compared to PCI.  Rate of MI was similar for both the procedures. Analysis from this review suggests that CABG greatly improves survival and re-intervention rate when compared to PCI, in diabetic patients with multi-vessel coronary artery disease.