Godoy LC, Lawler PR, Farkouh ME, et al. - Given a high prevalence of multivessel coronary artery disease (MVD) in patients with diabetes mellitus (DM) and coronary artery bypass surgery (CABG) supported as the optimal revascularization approach in the setting of stable ischemic heart disease, researchers looked for the best revascularization strategy in the acute situation, especially in patients with non–ST-segment elevation (NSTE) acute coronary syndrome (ACS) [NSTE-ACS]. An invasive and timely strategy (that is, performing coronary catheterization within 72 hours following the onset of the NSTE-ACS) is recommended by most guidelines, which also advise regarding opting between percutaneous coronary intervention (PCI) or CABG based on data for patients with stable ischemic heart disease. For patients with DM and MVD also in the NSTE-ACS setting, CABG might be preferred for revascularization, by recent observational and subgroup analyses; however, a lack of dedicated randomized clinical trials has been realized. Generally, PCI, instead of fibrinolysis or CABG, is preferred for initial revascularization in patients who present with an ST-segment elevation myocardial infarction, and this decision is not influenced by DM status in most of the cases. Still, there remains controversy regarding the management of residual MVD following primary PCI for ST-segment elevation myocardial infarction.