Background : To date there have been few studies comparing minimally invasive bypass surgery (MIDCAB) and Drug-Eluting Stents (DES) regarding the treatment of ostial lesion of LAD. We sought to compare the clinical outcomes in patients with ostial lesion of LAD following two procedures. Methods : Medical records of 257 symptomatic patients (surgery 101 vs. DES 156) who received either treatment for ostial lesion of LAD in our institute from Mar.2003 to Nov.2006 were reviewed. Clinical end point was defined as the occurrence of major adverse cardiac events (MACE). Results : During the mean follow-up of 30.3짹18.4 months, MACE occurred in 10 patients in DES group and 9 patients in MIDCAB group. There was single non-cardiac death in MIDCAB group and no cardiac death in both groups. One case of cererbovascular accident occurred in DES group, and one case of NSTEMI in MIDCAB group. The rate of repeated revascularization of target vessel did not differ between both groups (p=0.33). The length of hospital stay of DES group was significantly shorter than that of MIDCAB group (2.2짹1.2 days vs. 6.5짹4.8 days, p<0.001). By Cox-regression analysis, no significant difference was found between two groups in terms of incidence of MACE according to time duration (HR=0.719,95% CI=0.291-1.778). Conclusions : In our study, both DES implantation and MIDCAB were an equally safe and effective treatment option for patients with the ostial lesion of LAD. DES implantation seems to have the benefit of shortening the length of hospital stay.