OBJECTIVE We performed the long-term follow-up of large cohort of patients receiving left main coronary artery (LMCA) revascularization from the multi-center. BACKGROUND Limited information is available on long-term outcomes for patients with unprotected LMCA disease who underwent coronary stents or coronary-artery bypass grafting (CABG). METHODS We evaluated 2,240 patients with unprotected LMCA disease who received coronary stents (n=1,102; 318 with bare-metal stents [BMS] and 784 with drug-eluting stents [DES]) or underwent CABG (n=1,138) between 2000 and 2006 and for whom complete follow-up data were available for at least 3 to 9 years (median, 5.2 years). The 5-year adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction [MI], or stroke; and target-vessel revascularization [TVR]) were compared with the use of the inverse-probability-of-treatment-weighted method and propensity-score matching. RESULTS After adjustment for differences in baseline risk factors using the inverse-probability-of-treatment-weighting, the 5-year risk of death (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.88-1.44, P=0.35) and the combined risk of death, Q-wave MI, or stroke (HR, 1.07; 95% CI, 0.84-1.37, P=0.59) were not significantly different for patients undergoing stenting versus CABG. The risk of TVR was significantly higher in the stenting group than in the CABG group (HR, 5.11; 95% CI, 3.52 to 7.42, P<0.001). Similar results were obtained in comparisons of BMS with concurrent CABG and of DES with concurrent CABG. In further analysis using propensity-score matching, overall findings were consistent. CONCLUSIONS During 5-year follow-up, stenting showed similar rates of mortality and of the composite of death, Q-wave MI, or stroke, but higher rates of TVR as compared with CABG for patients with unprotected LMCA disease.