Background: The precise benefit/risk ratio of either procedure in patients with ischemic cardiomyopathy remains less clear. Objectives: This study aimed to assess the twelve months outcome of drug eluting stent (DES) versus off-pump CABG (OPCAB) for proximal left anterior descending (LAD) Lesions in ischemic cardiomyopathy. Methods: 70 patients diagnosed as ischemic cardiomyopathy with EF < 35% referred for revascularization were assigned to either stenting or surgery. The primary endpoint was (ISR/graft occlusion) rates; the secondary endpoint was MACE at 12 months follow up. Results: Out of 70 Patients enrolled; 71.4% % were assigned to DES while 28.6% were assigned to OPCAB; The mean SYNTAX score for stent group was 17.5 ± 0.96 while the mean Euro-score II for the surgery group was 3 ± 0.86.The ISR/graft occlusion rates; angina; and TVR were significantly higher among the stenting group (30% Versus 5%; P = 0.028) ; (4% Versus 25%; P = 0.017)and ( 22% Vs0%, P=0.028) respectively while late TIA/ stroke and length of hospital stay were significantly higher among the surgery group (2% Versus 20%; P = 0.021)and (2 ± 0.5 days vs 7.2 ± 0.5, P<0.001) respectively ; Similar survival rates among the two groups. The relative risk of ISR/graft occlusion is 6 times more among the stent group compared to the surgery group (p = 0.028)., Conclusion: Similar survival rates at twelve months follow up among the two groups; stent carries more risk of ISR; repeat revascularization while surgery carries more risk of late stroke.