Objective: To compare the safety and efficacy of coronary artery bypass grafting (CABG) with drug-eluting stent (DES) in patients with unprotected left main coronary artery (ULMCA) disease. Methods: Pubmed,EMBASE and Cochrane Library Database were searched for randomized controlled clinical studies that reported outcomes comparing PCI with DES with CABG for the treatment of ULMCA disease. Primary outcomes were death, myocardial infarction(MI), cerebrovascular accident(CVA), major adverse cardiac and cerebrovascular events(MACCE) and repeat revascularization. Result: At one-year follow-up, there was no significant difference between the CABG and DES group in the risk for death（OR 0.73,95%CI 0.43-1.26）,MI（OR 1.09,95%CI 0.59-2.01）,MACCE（OR 2.21,95%CI 1.51-3.22）. The risk of CVA was significantly lower in the DES group compared with the CABG group（OR 0.18,95%CI 0.05-0.70）,but higher risk of repeat revascularization（OR 2.21,95%CI 1.51-3.22）.Conclusions: PCI with DES is associated with favorable outcomes for death,MI,MACCE and a low risk of CVA compared to CABG in patients with ULMCA disease,but with a higher risk of repeat revascularization .