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Revascularisation of multivessel coronary artery disease (MVD) can be accomplished by either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. An individual-patient-data pooled analysis from eight randomised controlled trials (RCTs) that assigned 7040 patients with MVD (without left main disease) to PCI versus CABG demonstrated lower 5-year mortality with CABG (8.9% vs 11.5%, p=0.0019).1 This benefit was mostly evident in higher-risk patients with diabetes mellitus (10.5% vs 15.5%, p=0.0004); mortality after PCI and CABG was similar in patients without diabetes (8.0% after CABG vs 8.7% after PCI, p=0.49) (Pinteraction=0.045). While the interaction was not significant between revascularisation modality and SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) score for mortality, survival was also better after CABG in patients with intermediate and high coronary anatomic complexity. Other meta-analyses have consistently shown that CABG increases the rate of peri-procedural stroke but reduces non-procedural myocardial infarction (MI) and unplanned repeat revascularisation in MVD compared with PCI.2 On the basis of these and other studies, the most recent guidelines for management of chronic coronary syndromes (2024 from the European Society of Cardiology, endorsed by the European Association for Cardio-Thoracic Surgery2), provide CABG a class IA recommendation to improve outcomes compared with PCI and medical therapy in patients with MVD with diabetes. PCI is provided a class 1A recommendation in patients with three-vessel disease with low-intermediate anatomic complexity without diabetes if equivalent revascularisation can be achieved as with CABG, and in all patients with two-vessel disease.