At the beginning of this year, the long term mortality of the SYNTAX trial based on the left ventricular function was published in this journal [ ]. The current guidelines recommend coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) for multivessel disease patients with ejection fraction of less than 35 %. However, long term follow-up of multivessel and left main patients has not revealed the influence of left ventricular function on survival. Now with the 10-year follow-up of SYNTAX complete, the impact of left ventricular function was examined. The authors looked at three groups: those with preserved ejection fraction, defined as greater than 50 %; mildly reduced ejection fraction, as 40–49 %; and reduced ejection fraction of less than 40 %. Ten-year mortality was 22.6 % for those with preserved ejection fraction, 31.8 % for those with mildly reduced ejection fraction, and 44.0 % for the reduced ejection fraction group.