A 72-year-old diabetic woman has multivessel coronary artery disease with SYNTAX score of 33 and preserved LVEF. She is otherwise operable. According to SYNTAX trial data and current guidelines, what revascularization strategy is recommended?

• A PCI with drug-eluting stents (DES) to all vessels
• B CABG (coronary artery bypass grafting) ✓
• C Optimal medical therapy alone
• D PCI only to the culprit vessel, medical therapy for others

Explanation

The SYNTAX trial established that for complex multivessel or left main disease (SYNTAX score >22–33), CABG is superior to PCI with DES in terms of MACE (major adverse cardiovascular events), repeat revascularization, and stroke-free survival, particularly in diabetics. For SYNTAX score ≥33 (high complexity), CABG is the Class I recommendation. The FREEDOM trial specifically confirmed CABG superiority over PCI in diabetics with multivessel disease. Optimal medical therapy alone is reserved for stable patients refusing revascularization.

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

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Written and medically reviewed by the StethoPrep medical team.