Background: Recent studies showed that chronic kidney disease(CKD) is one of risk factors of coronary artery disease(CAD). The management of CAD associated with CKD is a challenging problem for cardiologists. We were interested in how often CKD was associated with CAD and the effects of CKD on long-term prognosis. Furthermore, we examined the impact of treatment strategy(CABG or PCI) on long-term prognosis of CKD patients with multivessel disease(MVD). Method: CKD patients hospitalized from 2001 to 2006 for their first coronary revascularization procedures were identified from the Seoul national university hospital database. Patients with ST elevation myocardial infarction were excluded. The kidney function was ascertained by estimated glomerular filtration rate(eGFR) calculated using MDRD equation. For comparing treatment options in CKD patients with MVD, primary end points were all cause death and MI. Results: Incidence of CKD(eGFR<60ml/min/1.73m2) was 23.6% in patients who underwent PCI(n=2519) and 21.0% in patient who underwent CABG(n=901). Incidence of CKD increased from 12.2%(2001) to 30.1%(2006) in PCI patients and from 18.2%(2001) to 29.5%(2006) in CABG patients. After a mean follow up period of 2.4짹1.4 years, mortality was associated with eGFR in both PCI and CABG group. In patients with CKD and MVD, long-term prognosis is associated with age and LVEF, but not with treatment strategy(CABG or PCI). However when patients were stratified by the eGFR, treatment strategy seemed to have some effects in a subgroup of patients whose eGFR was between 45 and 59. In this subgroup, those without heart failure had better long term outcome after PCI than after CABG(p=0.046). In those patients with heart failure, CABG tended to do better, but not reached to a statistically significant level(p=0.273). Conclusion: In Korea, incidence of CKD in patients who are undergoing coronary revascularization is more than 20% and continues to increase. CKD is one of the most important prognostic factors after coronary revascularization. In CKD patients with MVD, PCI showed similar outcomes compared with CABG. However in CKD patients without heart failure, PCI might be a preferred treatment strategy with better prognosis.