Objective In severe ischemic mitral regurgitation (IMR), there is benefit evidence for mitral valve repair with coronary artery bypass grafting (CABG). However, there is still a debate around combined repair and CABG for moderate IMR. We evaluate our results over 4-year follow-up for patients with moderate IMR who underwent isolated CABG and combined with mitral ring annuloplasty. Methods We retrospectively studied patients with moderate IMR; 69 patients underwent CABG alone group (A), and 77 patients underwent CABG with mitral valve ring annuloplasty group (B). New York Heart Association functional class (NYHA class), mitral regurgitation (MR) grade, and left ventricle (LV) dimension and ejection fraction (EF) were assessed preoperatively, 1 and 4 years postoperatively. Results The mortality rate was 2.9% in group (A) and 1.8% in group (B) p = 0.1593. Improvement in NYHA class, MR, and LVEF % were significant in both groups at 1 year with no significant changes at 4 years. However, group (B) showed significant improvement in LVEF % than group (A) at 4 years (47.5 ± 7.3 vs 44 ± 1.7, p 0.0001). It showed improvement in NYHA class at 1 and 4 years (1.5 ± 0.4 vs 2.1 ± 0.2) and (1 ± 0.2 vs 1.5 ± 0.5) p 0.0001, respectively. After 4 years, group (A) showed deterioration of MR degree in 4.3% of patients. Conclusion We strongly advise to add mitral valve ring annuloplasty with CABG for patients with moderate IMR.