A 60-year-old woman with stable angina has left main coronary artery stenosis of 62% on invasive angiography. Left ventricular ejection fraction is 55%. She has no diabetes. Which revascularization strategy is preferred?

• A PCI with drug-eluting stent
• B CABG ✓
• C Optimal medical therapy alone
• D Fractional flow reserve (FFR) guided deferral

Explanation

Significant left main CAD (≥50% stenosis by angiography or hemodynamically significant by FFR/iFR) with preserved LVEF is a Class I indication for CABG, which provides superior long-term outcomes compared to PCI, particularly for complex anatomy and overall survival. The EXCEL and NOBLE trials showed non-inferiority of PCI in low-to-intermediate SYNTAX scores, but guidelines still favor CABG for left main disease when anatomy is suitable. Medical therapy alone is inadequate for significant left main disease.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.