A 58-year-old man with NSTEMI undergoes coronary angiography. He has a 90% stenosis in the proximal LAD and a 75% stenosis in the mid-RCA. His SYNTAX score is 16. What does this SYNTAX score determine regarding revascularisation strategy?

• A SYNTAX score 16 (low) favours CABG over PCI for equivalent outcomes
• B SYNTAX score 16 mandates medical management alone
• C SYNTAX score is only applicable for left main disease
• D SYNTAX score 16 (low) supports PCI as equivalent to CABG with acceptable outcomes ✓

Explanation

The SYNTAX trial established that a SYNTAX score ≤ 22 (low) indicates PCI outcomes are comparable to CABG in multi-vessel disease, supporting PCI as an acceptable revascularisation strategy. Intermediate scores (23–32) require Heart Team discussion, while high scores (> 32) favour CABG. The SYNTAX score applies to multi-vessel and left main disease.

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

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