A 70-year-old woman has an NSTEMI and is found to have three-vessel coronary artery disease with preserved LV ejection fraction (55%). Her SYNTAX score is 32. Which revascularization strategy is preferred per current guidelines?
- A CABG is preferred over PCI for three-vessel CAD with high SYNTAX score (≥ 23) ✓
- B Medical therapy alone — high SYNTAX score is a contraindication to any revascularization
- C PCI of the culprit vessel only (ad hoc)
- D PCI of all three vessels in the same session
Correct answer: A. CABG is preferred over PCI for three-vessel CAD with high SYNTAX score (≥ 23)
Explanation
For patients with three-vessel CAD, current guidelines (ESC/ACC/AHA) recommend CABG over PCI when the SYNTAX score is ≥ 23, as CABG provides superior outcomes (lower MACE, lower revascularization rates) in this anatomical complexity group. PCI is acceptable in lower SYNTAX scores (≤ 22) for three-vessel disease. Medical therapy alone is not the strategy when revascularization is feasible. Complete multi-vessel PCI in the acute setting is not the default standard for stable three-vessel 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.