Background: Coronary artery disease (CAD) dominates in the contemporary world among the causes of left ventricular dysfunction (LVD). Prognosis of survival and the course of heart failure (HF) are worse in patients with CAD than in many kinds of non-ischemic cardiomyopathy. Development of cardiac surgery technologies and formation of the relevant evidence base have significantly expanded the role of revascularization in patients with CAD and reduced left ventricular ejection fraction (LVEF). The possibility and expediency of coronary artery bypass grafting (CABG) for improving left ventricular ejection fraction (LVEF), clinical course of HF and survival are evidence-based. Stenting is less effective than coronary artery bypass grafting (CABG) regarding the influence on primary endpoints but improves the quality of life of patients with CAD and ischemic LVD. Conclusions: In patients with ischemic LVD, surgical revascularization can ensure an improvement in the pumping function of the heart, provided there is a sufficient amount of viable myocardium. From the standpoint of evidence-based medicine, the effectiveness of CABG surgery in patients with multivessel lesion of the coronary bed and LVD has been proven for correction LVEF, improvement of the course of the disease and prediction of survival compared with the optimal drug therapy. Percutaneous intervention is inferior to surgical revascularization in terms of its effect on endpoints, but it can make an improvement in the quality of life of patients with ischemic LVD. Evaluation of myocardial viability may be of additional importance for the decision on the feasibility of CABG in the presence of multivessel coronary artery disease combined with a sharp decrease in LVEF.