Background: The long-term outcome of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) has not been well known in patients with distal unprotected left main coronary artery (ULMCA) disease. Methods: Between Jan, 2000 and June, 2006, a total of 1141 patients with distal ULMCA stenosis were collected from 12 academic centers in Korea. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were performed in 575 patients and 566 patients, respectively. Results: Patients with PCI showed a higher incidence of previous PCI. In contrast, patients with CABG had a higher incidence of peripheral vascular disease, family history of coronary artery disease and had lower ejection fraction and higher Euroscore and more presented with acute coronary syndrome. During long-term follow-up of median 32.6 months, there was no difference of the rates for death, Q-wave myocardial infarction and CVA. However, patients with PCI showed a significantly higher incidence of target vessel revascularization than those with CABG. This trend was persistent in comparison between drug-eluting stents and CABG (Table). Conclusions: There was no difference in the rates for death, Q-MI and CVA in patients with distal ULMCA disease after percutaneous or surgical treatment. However, PCI without regard to stent type was significantly associated with target vessel revascularization than bypass surgery.