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SYNTAX Score and Revascularisation Decision — EECC MCQ

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ModerateCoronary Artery DiseaseSYNTAX Score and Revascularisation DecisionEECC

A 70-year-old man with NSTEMI and three-vessel disease is discussed at the Heart Team meeting. The SYNTAX score is 23 (intermediate). He has no diabetes and an LVEF of 55%. What revascularisation strategy does the 2024 ESC CCS guideline recommend?

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Correct answer: D — Either CABG or PCI may be considered for three-vessel disease with an intermediate SYNTAX score (23-32) without diabetes; the decision should be individualised by the Heart Team considering anatomy, comorbidities, and patient preference

The SYNTAX score categorises anatomical complexity into tertiles: low (0-22), intermediate (23-32), and high (≥33). For three-vessel disease: low SYNTAX (≤22) without diabetes — PCI and CABG have similar outcomes; CABG or PCI can be considered. Intermediate SYNTAX (23-32) — either CABG or PCI may be considered (Heart Team decision). High SYNTAX (≥33) — CABG is recommended over PCI (based on SYNTAX 10-year data showing CABG superiority). The presence of diabetes shifts the recommendation toward CABG at lower SYNTAX thresholds (FREEDOM trial). The 2024 ESC CCS Guidelines maintain the SYNTAX score as a key tool for guiding the PCI vs CABG decision in multivessel disease.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes