Background Left ventricular (LV) dysfunction is known to be an independent risk factor of major adverse cardiac events. However, there have been limited data whether there are clear association between LV dysfunction and the angiographic and long term clinical outcomes in patients (pts) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). Methods The study population consisted of 711 consecutive pts underwent PCI with DES from November 2005 to June 2008. We compared six months angiographic and two years clinical outcomes among the pts with mild (LVEF: 40-50%, n= 453 pts, 63.7%), moderate (LVEF: 20-39%, n= 242 pts, 34.0%) and severe (LVEF: < 20%, n= 16 pts, 2.3%) LVdysfunction. Results Three groups had similar baseline clinical and procedural characteristics except severe LV dysfunction group had more diabetes, smoker and less dyslipidemia compared with other two groups. Six-month angiographic outcomes were similar among the three groups. At 2 years, there was a trend toward higher incidence of cardiac death and higher incidence of target vessel revascularization (TVR)-major adverse cardiac events (MACE) and total MACE in the severe LV dysfunction group. Multivariate analysis showed that low LVEF was an independent predictor of total MACE at 2 years (Adjusted OR: 1.715, 95% CI:1.115-2.638, p-value=0.014,Table). Conclusions In our study, severe LV dysfunction at baseline was associated with higher incidence of TVR-MACE and total MACE up to 2 years. LV dysfunction was an independent predictor of total MACE in pts undergoing PCI with DES in real world clinical practice.