Introduction: The effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in patients with coronary artery disease has been well established in randomized controlled trials. However, patients with severe left ventricular dysfunction (ejection fraction <35%) were under-represented in these studies and the management of these complex patients remains unclear. The aim of the study was to compare the treatment results in patients with coronary artery disease and left ventricular dysfunction undergoing CABG and PCI. Place and Duration: In the cardiac Surgery Department of Allied Hospital Faisalabad for three-years duration from June 2017 to June 2020. Methods: 2,925 patients with coronary disease and left ventricular dysfunction undergoing CABG (n [1,326) or PCI (n [1599) were evaluated. Patients were matched for propensity to obtain comparable subgroups among patients with left ventricular dysfunction. Results: Analysis of Cox proportional hazards in the propensity-matched subgroups showed that CABG was significantly associated with a lower rate of repeat revascularization and better survival compared to PCI. Other significant independent predictors of poor long-term survival included age, renal failure, heart failure, diabetes, peripheral vascular disease, previous myocardial infarction, left coronary artery disease, and prior CABG. Conclusions: In patients with coronary artery disease and left ventricular dysfunction, CABG was associated with a lower rate of revascularization and improved survival after PCI, taking into account differences in the baseline risk profile. More research is needed on the factors that lead to a specific revascularization method in this patient population. Key words: coronary artery disease, left ventricular dysfunction, CABG, revascularization.