Background: Great interest exists in the relative efficacy of coronary artery bypass graft surgery(CABG) versus percutaneous coronary intervention(PCI) for the treatment of left main coronary artery disease(LMCD). However, left main coronary disease in chronic kidney disease(CKD) patients has not been well evaluated. Method: From Jan 2001 to Dec 2006, all patients with LMCD treated with either PCI or CABG have been collected in SNU PCI and CABG database. The exclusion criteria were AMI within one week and history of coronary revascularization. Primary end points were all cause death and myocardial infarction. The patients were stratified by the level of eGFR and we evaluated the clinical outcomes after CABG or PCI for LMCD. Results: 365 patients with LMCD were treated with PCI(n=76) or CABG(n=289). Median follow up was 1.3짹1.1 years in PCI group and 2.8짹2.2 years in CABG group. When we analyzed the long term survival by the level of kidney function, CKD(eGFR<60) is associated with a worse prognosis both in patients undergoing CABG and in those treated with PCI. Regardless of baseline kidney function there was no statistical difference in the occurrence of death and myocardial infarction in PCI versus CABG (figure). Conclusion: Chronic kidney disease is an independent prognostic factor after PCI or CABG in patients with LMCD. Our results have indicated that at long-term follow-up, regardless of kidney function, no difference exists in the rate of mortality and myocardial infarction between PCI and CABG for the treatment of LMCD.