Background: Ostial disease of the left anterior descending (LAD) coronary artery is a challenge for the interventional cardiologist. The aim of this study was to compare the clinical and angiographic outcomes between cross-over and precise stenting strategy for the treatment of LAD ostial coronary lesions. Methods: From Jan. 2005 to May 2009, 118 consecutive patients with LAD ostial lesions underwent PCI at 3 centers were enrolled. Patients were divided into two groups according to the therapeutic strategies; cross-over stenting (CS, n=56) and precise stenting (PS, n=62). The study end-point was composite of major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI) and ischemic driven target vessel revascularization (TVR) for 12 months. Angiographic follow up was performed at 9-12 months, and vessel diameter change at left main, LAD and LCX were analyzed. Results: At 1 year follow-up, total MACE was 12.7% in CS group and 11.5% in PS (p=0.836) and total target lesion revascularization (TLR) rate was 7.3% in CS group and 9.8% in PS (p=0.746). Binary angiographic restenosis at left circumflex (LCX) coronary artery was statistically different at both group (4 in CS group and 0 in PS group, p=0.002). At angiographic follow up, late loss of CS group was 0.07짹0.28mm at LM, 0.14짹0.43mm at LAD, 0.22짹0.94mm at LCX and it of PS group was 0.07짹0.68mm at LM, 0.10짹0.52mm at LAD, 0.12짹0.79. Conclusions: Cross-over and precise stenting strategy for LAD ostial lesion showed similar clinical outcomes, but precise stenting was more favorable to LCX protection.