Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease

Inclusion Criteria: * The patient must be at least 18 years of age. * Significant de novo left main stenosis (\>50% by visual estimation) with or without any additional target lesions (\>70% by visual estimation) * Left main lesion and lesions outside LMCA (if present) potentially equally treatable with coronary stenting and bypass surgery * Patients with stable (CCS class 1 to 4) or acute coronary syndromes (unstable angina pectoris Braunwald class IB, IC, IIB, IIC, IIIB, IIIC or NSTEMI) or patients with atypical chest pain or without symptoms but having documented myocardial ischemia * The patient or guardian agrees to the study protocol and the schedule of clinical and angiographic follow-up, and provides informed, written consent, as approved by the appropriate Institutional Review Board/Ethical Committee of the respective clinical site. Exclusion Criteria: * The patient has a known hypersensitivity or contraindication to any of the following medications: * Heparin * Aspirin * Both Clopidogrel and TIclopidine * Sirolimus, paclitaxel, ABT 578 * Stainless steel and/or * Contrast media (patients with documented sensitivity to contrast which can be effectively pre-medicated with steroids and diphenhydramine \[e.g. rash\] may be enrolled. Patients with true anaphylaxis to prior contrast media, however, should not be enrolled). * Systemic (intravenous) Sirolimus, paclitaxel or ABT-578 use within 12 months. * Any previous PCI within 1 year * Previous bypass surgery * Any previous PCI of a LMCA or ostial left circumflex artery or ostial left anterior descending artery lesion within 1 year * Intention to treat more than one totally occluded major epicardial vessel * Acute MI patients within 1 week * Patients with EF\<30%. * Patients with cardiogenic shock * Any disabled stroke with neurological deficit or any cerebrovascular accident within 6 months * Creatinine level \> 2.0mg/dL or dependence on dialysis. * Severe hepatic dysfunction (AST and ALT \> 3 times upper normal reference values). * Gastrointestinal or genitourinary bleeding within the prior 3 months, or major surgery within 2 months. * History of bleeding diathesis or known coagulopathy (including heparin-induced thrombocytopenia), or will refuse blood transfusions. * Current known current platelet count \<100,000 cells/mm3 or Hgb \<10 g/dL. * An elective surgical procedure is planned that would necessitate interruption of thienopyridines during the first 1 year post enrollment. * Non-cardiac co-morbid conditions are present with life expectancy \<1 year or that may result in protocol non-compliance (per site investigator's medical judgment). * Patients who are actively participating in another drug or device investigational study, which have not completed the primary endpoint follow-up period. * Subject unable or unwilling to follow-up with visits required by protocol * Female of childbearing potential, unless a recent pregnancy test is negative, who possibly plan to become pregnant any time after enrollment into this study