| Summary: | Background: The decision-making factors and long-term clinical outcomes between PCI and CABG in left main (LM) disease are still not well defined in the real world. Methods: We evaluated consecutive patients (<i>n</i> = 230) with LM disease either treated by PCI (<i>n</i> = 118) or CABG (<i>n</i> = 112). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction (MI), stroke, and target vessel revascularization (TVR) for 7 years. Results: In the multivariate-adjusted analysis, the presence of intermediate EuroSCORE II and high SYNTAX scores predisposed to CABG. Isolated LM disease was associated with receiving PCI. The PCI group had a similar rate of MACE (HR<sub>adj</sub> 0.97, 95% CI [0.48–1.94], <i>p</i> = 0.92) and a lower tendency of hard MACE (HR<sub>adj</sub> 0.49, 95% CI [0.22–1.07], <i>p</i> = 0.07) compared to the CABG group, mainly due to the balance between a higher rate of TVR (HR<sub>adj</sub> 9.71, <i>p</i> = 0.02) and a lower rate of stroke (HR<sub>adj</sub> 0.22, <i>p</i> = 0.09) with the PCI group than in the CABG group. Conclusions: The decision making of treatment strategy was made based on clinical and angiographic factors. The selected patients who received PCI showed similar MACE and trend of a lower rate of composite hard endpoints despite multivariate adjustment.
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