PCI is an important tool in the treatment of coronary artery disease, but has been plagued by in-stent restenosis and higher restenosis rates after intervention for coronary multiple lesions. Both DES and CABG are safe and feasible for the treatment of multiple coronary artery lesions, have similar endpoint event rates, and both improve patient prognosis, with the advantages of DES focusing on lower rates of nonfatal cerebrovascular accidents and shorter hospital stays, and the advantages of CABG focusing on lower rates of target revascularization. Cardiovascular interventionalists should carefully assess the risk factors of patients with multiple coronary artery lesions and select the appropriate treatment to achieve true individualized treatment and maximize patient benefit. The treatment options for coronary artery disease include medications, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), etc. PCI and CABG are more effective in the treatment of myocardial infarction and the prevention of post-infarction heart failure because they rapidly restore perfusion to the ischemic myocardium. In recent years, with the rapid advancement of interventional devices and techniques for coronary atherosclerotic heart disease (CHD), many areas that were previously “off-limits” to interventionalists, such as complex coronary lesions, have become the domain of cardiovascular interventionalists. Complex coronary lesions currently recognized by interventionalists include: multiple coronary lesions (≥2); chronic occlusive lesions; diffuse long lesions (lesion length >30 mm); small vessel lesions (lesion vessel diameter <2.5 mm); bifurcation lesions with branch vessel diameter >2.0 mm; severe tortuosity or severe angular lesions (maximum angulation >45° on multi-angle angiography); left main lesions; severe calcified lesions; bridge vessel lesions, etc. (1-3). Among these many complex coronary lesions, the most common is multi-branch coronary artery lesions. Coronary intervention (PCI) is an important tool in the treatment of coronary artery disease, but it has been plagued by in-stent restenosis, and the restenosis rate is even higher after intervention for coronary multi-branch lesions. The introduction of drug-eluting stents has solved the problem of restenosis after bare stenting through the continuous and stable release of drugs from the stent coating to inhibit the hyperproliferation of the intima, and the efficacy is better than that of bare stents, which is regarded as the third revolution in the history of interventional treatment. For multi-branch coronary lesions, traditional revascularization strategies include CABG and PCI, but due to the high surgical trauma of CABG, many perioperative complications, and contraindications to the procedure in some patients, many patients cannot undergo CABG and opt for PCI treatment. In the era of bare stenting, such patients have a high rate of in-stent restenosis after the application of bare stenting, which makes the treatment of such patients encounter a bottleneck that is difficult to break through. The results of the ARTS II trial (4) showed that the 1-year mortality rate of patients with rapamycin drug-eluting stents was 1.0%, the incidence of myocardial infarction was 1.2%, the incidence of stroke was 0.8%, the incidence of MACCE was 10.4%, and the target vessel revascularization rate was 8.5%. The incidence of major adverse cardiovascular events in the rapamycin drug-eluting stent group was generally comparable to that in the CABG group, and the incidence of 1-year mortality, cerebrovascular accidents, and myocardial infarction was lower than that in the CABG group, but the target revascularization rate was higher than that in the CABG group. A meta-analysis of studies comparing the efficacy of PCI versus CABG for coronary multiple lesions was performed, in which four clinical studies included 3051 patients (6-9), and these studies looked at the safety and efficacy of PCI and CABG for patients with coronary multiple lesions 5 years after the procedure. The cumulative incidence of death, nonfatal myocardial infarction, and nonfatal cerebrovascular accidents was found to be similar in the PCI and CABG groups at 5 years post-procedure (P>0.05). However, the rate of target revascularization was significantly higher in the PCI group than in the CABG group (P<0.01). This meta-analysis suggests that the long-term safety of PCI and CABG is similar in the treatment of multiple coronary artery lesions. However, the rate of target revascularization was lower in the CABG group, and the overall MACCE was significantly lower in the CABG group than in the PCI group at 5 years after the procedure. The SYNTAX study, published in the New England Journal in March 2009 (10), is a large multicenter clinical study divided into 2 parts: a randomized controlled study and a registry study comparing the efficacy of drug-eluting stents (DES) with CABG in the treatment of landmark 3-branch coronary lesions (3VD) and left main stem (LM) lesions. The randomized controlled study included 1,800 patients randomized to the CABG group (897 patients) and the PCI group (903 patients, all with TAXUS Express stents). The primary clinical endpoint of the study was the rate of major cardiovascular and cerebrovascular events (MACCE) at 1-year follow-up, including all-cause death, nonfatal cerebrovascular accident, nonfatal myocardial infarction, and revascularization. 1275 patients were enrolled in the study, 1077 in the CABG registry and 198 in the PCI registry. The differences in all-cause mortality, non-fatal myocardial infarction rate, combined all-cause death/cerebrovascular accident/non-fatal myocardial infarction rate, graft occlusion or in-stent thrombosis rate were not statistically significant in the CABG group compared with the PCI group (P > 0.05); however, the rates of non-fatal cerebrovascular accident (2.2% vs 0.6%), revascularization (5.9% vs 13.7 However, the rates of nonfatal cerebrovascular accidents (2.2% vs 0.6%), revascularization (5.9% vs 13.7%), and MAACE (12.1% vs 17.8%) were statistically significantly different (P 0105); the incidence of MACCE at 12 months of PCI was significantly higher in patients with SYNTAX scores of 23 to 32 versus ≥33 (P < 0.05). Therefore, SYNTAX score for multiple coronary artery lesions can effectively differentiate between patients with high-, low-, and intermediate-risk coronary artery disease and further select safer and more effective treatments for patients. Diabetic patients often have complex coronary artery lesions such as multi-branch lesions and left main stem lesions. Regardless of the type of revascularization chosen, the outcome of coronary revascularization in diabetic patients is poorer than that in non-diabetic patients, and the clinical outcome of revascularization in diabetic patients requiring insulin therapy may be even worse (13). A study comparing the effects of PCI and CABG on the long-term prognosis of patients with multiple coronary artery lesions suggested that the outcomes of patients with multiple coronary artery lesions after PCI were comparable to those of CABG (14). The analysis found that the mortality rate was only 0.9% higher in the CABG group than in the interventional group at 5 years of follow-up, and the difference in mortality rates between the two revascularization modalities was not statistically significant. The findings suggest that the 2-year follow-up after DES placement in diabetic patients with multiple coronary artery lesions is similar to that of CABG (12.9% vs 13.3%, P>0.05). Therefore, standardized and effective pharmacological treatment and contemporary advances in revascularization techniques are important factors in improving revascularization outcomes in diabetic patients. However, although DES placement significantly reduces the rate of revascularization in patients with multiple diabetic lesions, the rate of revascularization is still higher than that in the CABG group because coronary interventions often fail to completely revascularize and a certain percentage of restenosis remains in DES, which is the main reason why the overall rate of MACCE is higher in the DES group than in the CABG group. Therefore, even in the era of DES, CABG therapy is still the ideal mode of revascularization for patients with diabetic multibranch lesions. The above clinical trials have shown that both DES and CABG are safe and feasible in the treatment of multiple coronary artery lesions, with similar endpoint event rates and improved prognosis, with the advantages of DES focusing on lower rates of nonfatal cerebrovascular accidents and shorter hospital stays, and the advantages of CABG focusing on lower rates of target revascularization. Cardiovascular interventionalists should carefully assess the risk factors of patients with multiple coronary artery lesions and select the appropriate treatment to achieve true individualized treatment and maximize patient benefit.