Objectives: Current practice guidelines still recommend coronary artery bypass graft (CABG) as the standard treatment in patients with left main coronary disease (LMCD). The purpose of our study is to assess the real world selection of therapeutic strategy in patients with LMCD and their outcomes using by SYNTAX and euroSCORE. Methods: We analyzed data of 100 consecutive patients with significant LMCD treated by percutaneous coronary intervention with DES (n=44) or CABG (n=56). All lesions of the LMCD were de novo lesions. We calculate the SYNTAX score and the euroSCORE and assessed the clinical outcomes during 1 year. Results:Patients baseline characteristics between groups were well balanced including logistic euroSCORE (3.54짹3.98% in the PCI group and 3.28짹2.47% in the CABG group, P=0.699). The PCI with DES on LMCD was adopted in patients with low SYNTAX score compared with those of the CABG group (22.0짹7.6 vs. 35.9짹8.6, P=0.000). These differences of two groups were derived by the number of coronary artery lesion (2.8짹1.1 vs. 4.0 짹1.3 lesions, P=0.000) and presence of chronic total occlusion artery (9.0%(4/44) vs. 46.4%(26/56), P=0.000). 1 year major adverse cardiac events rates did not differ between PCI with DES group and CABG group (6.8% (3/44) vs. 3.5% (2/56), P=0.465). And this result of MACE continued in low-intermediate SYNTAX group (6.6%(1/15) vs. 2.0%(1/49) P= 0.516). All MACE were cardiac death during hospitalization and further events including cardiac death, non-fatal myocardial infarction, need for revascularization procedures did not develop during follow up period after discharge. Mortality rates according to SYNTAX score in all LMCD patients were 2.7% (1/37) of low score group (���22), 3.7% (1/27) of intermediate score group (23 to 32), and 8.3% (3/36) of high score group (���33), however, statistical significance did not significant. Conclusions: Single center real world experience showed therapeutic strategy by PCI with DES in LMCD was usually adopted in patients with low SYNTAX score and had low incidence of MACE during 1 year. However, CABG still remains the dominant revascularization strategy, especially in the patients with high SYNTAX score. Prospective, long term, randomized study to evaluate the clinical outcomes between PCI and CABG are warranted in LMCD with high SYNTAX score. Keywords: SYNTAX score, Left main coronary disease, PCI, CABG