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SYNTAX Score with Diabetes — EECC MCQ

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ModerateCoronary Artery DiseaseSYNTAX Score with DiabetesEECC

A 62-year-old man with NSTEMI undergoes angiography showing significant three-vessel disease with SYNTAX score of 28. He has diabetes. According to the SYNTAX score, what revascularisation strategy is recommended?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — SYNTAX score 23-32 (intermediate) with diabetes favours CABG over PCI based on the FREEDOM trial and SYNTAX trial data — CABG provides superior long-term survival in diabetic patients with multivessel disease

The SYNTAX score quantifies coronary anatomical complexity (0-83) and guides revascularisation strategy per the 2024 ESC CCS Guidelines: Low SYNTAX (0-22): PCI and CABG have comparable outcomes — either is acceptable. Intermediate SYNTAX (23-32): CABG generally preferred, especially with diabetes. High SYNTAX (≥33): CABG clearly superior (PCI not recommended). The FREEDOM trial specifically showed that CABG reduced all-cause mortality by 30% versus PCI in diabetic patients with multivessel disease (5-year mortality: 10.9% CABG vs 16.3% PCI). This patient's SYNTAX 28 with diabetes is firmly in CABG-favoured territory. The Heart Team decision integrates: SYNTAX score, diabetes status, LVEF, frailty, surgical risk (STS-PROM/EuroSCORE II), patient preference, and completeness of revascularisation achievable by each method.

Reference: ESC (2024): CCS Guidelines; FREEDOM/SYNTAX Trials