A 60-year-old man presents with NSTEMI. Coronary angiography reveals triple-vessel disease with proximal LAD involvement. His SYNTAX score is 28. According to current ESC NSTEMI guidelines (2023), what is the preferred revascularisation strategy?
- A CABG as preferred revascularisation ✓
- B Immediate PCI of the culprit lesion only
- C Complete revascularisation with PCI during index admission
- D Medical management alone given the complexity
Correct answer: A. CABG as preferred revascularisation
Explanation
A SYNTAX score of 28 falls in the intermediate range (23–32) for triple-vessel disease with proximal LAD involvement. ESC 2023 NSTEMI guidelines recommend a Heart Team discussion; for SYNTAX score >22 with complex three-vessel disease and proximal LAD, CABG has a Class I recommendation over PCI for improved survival, especially in diabetic patients or where complete revascularisation cannot be achieved by PCI.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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