Background: The management of ischemic mitral regurgitation represents a therapeutic challenge and is still controversial. The restoration of coronary blood flow reduces left ventricular remodeling and improves regional and global left ventricular function; this strategy is expected to attenuate ischemic mitral regurgitation.Objective: To evaluate the effect of successful total revascularization by PCI on the degree of ischemic mitral regurgitation.Methods: 36 patients with mild, moderate or severe ischemic MR were prospectively studied. All patients were subjected to proper clinical assessment, 12- lead ECG, transthorasic echocardiographic assessment before and 4 weeks after PCI. All of them underwent successful total PCI. Result: There was a significant improvement in ischemic MR degree after total revascularization using PCI for either single or multivessel disease in 56% of patients (p < 0.05) and we found that the most important predictor of ischemic mitral regurgitation improvement post total PCI was revascularization of totally occluded coronary artery (P= 0.03, Odds ratio= 11.8) or absence of DM (p= 0.04, Odds ratio= 5.5). In the present study, Patients with multivessel disease had 83% of severe IMR and all of them improved after PCI.Conclusion: Successful total revascularization using PCI may improve ischemic mitral regurgitation whether mild, moderate or severe degree. PCI to total coronary occlusion is the best to predict IMR improvement particularly in non diabetic patients.