Background: Percutaneous transluminal coronary angioplasty (PTCA) with stenting have become the first-line intervention for patients with proximal left anterior descending artery (LAD) lesion. Minimally invasive direct coronary artery bypass grafting (MIDCAB) has recently developed to reduce surgical invasiveness for LAD lesion. Although PTCA with stenting and MIDCAB are used frequently for treating LAD lesions, the preferable approach is unknown. Materials & Methods: 100 consecutive patients who underwent proximal or mid-LAD lesion revascularization with either MIDCAB (n=50) or PTCA with stenting (n=50) at the Korea University Hospital from January 2000 though December 2001 were enrolled. All data were obtained from chart review. Comparisons were performed between two groups. Results: In base line characteristics, unstable angina, diabetes, hypertension and hypercholesterolemia were very frequent in both groups, but with no statistically significant differences. In hospital results, there were no significant differences in major adverse cardiac events, stroke, or vascular complications between two groups. In one-year clinical outcomes, there were no differences in mortality (p=1.0) or myocardial infarction rate (p=0.5). Repeat percutaneous coronary intervention or coronary artery bypass graft (CABG) were performed in 0.0 % and 2.0 % of patients in the MIDCAB group versus 12.0 % and 2.0 % in the PTCA with stenting group respectively. The cumulative rates of target vessel revascularization were 2.0 % in the MIDCAB group versus 14.0 % in the PTCA with stenting group (p=<0.05). The hospital stay in MIDCAB group is longer than that in PTCA and stenting group.(p<0.05) Conclusion: The result of this single-center study shows that MIDCAB and PTCA with stenting have similar in-hospital and 1-year mortality rate. MIDCAB requires longer hospitalization, but the PTCA with stenting has higher 1-year target vessel revascularization.