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Objective This study was conducted to evaluate the impact of diabetes on patients with unprotected left main coronary artery (LMCA) disease treated with either percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG).Backgrounds Whether the effect of diabetes on patients with unprotected LMCA disease differs according to different strategy of revascularization (PCI or CABG) was unknown.Methods 823 consecutive patients having unprotected LMCA disease, who received drug-eluting stents (DES) (n=331) implantation or underwent CABG (n=492) were prospectively enrolled.We compared the effects of diabetes on clinical outcomes according to different strategy of revascularization.Results Among 823 eligible patients enrolled, 226 had diabetes.In the overall population, there were no significant difference of the rates of MACCE, the composite of death/MI/stroke, repeat revascularization, death, cardiac death and stroke.However, significantly higher incidences of MI (8.5% DM vs.2.2% no-DM; p=0.003) was observed in patients with diabetes.In the DES population, no significant differences were observed in occurrences of death, cardiac death, repeat revascularization and stroke.However, the risks of MACCE (32.2% DM vs.19.6% no-DM; p=0.040), the composite of death/MI/stroke (21.5% DM vs.7.2% no-DM; p=0.001) and MI (15.4 % DM vs.1.6% no-DM; p=0.000) were significantly higher in the diabetic patients compared with those without diabetes.In the CABG population, similar rates of all clinical endpoints were observed between the diabetic and nondiabetic group.Conclusion With current CABG techniques the disadvantages of diabetes on outcomes have been eliminated while they still persist for DES treatment of unprotected LMCA disease.