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Background: We compared the outcomes in patients with a low ejection fraction (EF) and multivessel coronary artery disease (CAD) who either underwent coronary artery bypass grafting (CABG) or received medical treatment (MT) after a viability study via dobutamine stress echocardiography (DSE). Methods: We considered patients with CAD and left ventricular ejection fraction (LVEF) <40% who were referred for DSE, and enrolled 106 patients (89% male, mean age: 55.8±9.7 years) with ≥4 viable segments. According to DSE, all the 106 patients were suitable for revascularization. We compared the outcomes between the patients who underwent CABG and those who received MT at a mean follow-up time of 8 months. Results: Both groups had similar baseline characteristics and rest EF. Thirty-three (31.1%) patients underwent CABG and 73 (68.9%) received MT. There was no significant difference between the CABG and MT groups in terms of mortality rate (9.1% vs. 11.0 %) and improvement in New York Heart Association functional class at follow-up. In the CABG group, patients with LVEF ≤25% had higher mortality compared to patients with LVEF >25% (100% vs. 40%, P< 0.05). Conclusion: The patients with CAD and a low EF had the same survival rate after both CABG and MT at mid-term follow-up. Long-term follow-up is needed to show the survival benefit of CABG in such patients with an acceptable extent of viable myocardium.