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CABG Survival Advantage Scenarios — EECC MCQ

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ModerateCoronary Artery DiseaseCABG Survival Advantage ScenariosEECC

A 62-year-old man with stable angina asks about the role of coronary artery bypass grafting versus PCI. In what clinical scenario does CABG provide the greatest survival advantage over PCI?

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

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Correct answer: A — Left main stem disease with a high SYNTAX score (≥33), three-vessel disease with diabetes, or complex multivessel disease with reduced LVEF — CABG provides superior long-term survival in these scenarios

The survival advantage of CABG over PCI is most pronounced in: (1) Left main disease with high SYNTAX score (≥33) — the EXCEL and NOBLE trials and 10-year SYNTAX follow-up demonstrate CABG superiority in complex anatomy; (2) Three-vessel disease with diabetes — the FREEDOM trial showed CABG reduced all-cause mortality by 30% relative to PCI in diabetic patients; (3) Complex multivessel disease (high SYNTAX) — the SYNTAX trial 10-year data showed CABG superiority for SYNTAX ≥33; (4) Multivessel disease with reduced LVEF — CABG revascularises more completely and provides protection against future events via bypass grafts. The 2024 ESC CCS Guidelines use the SYNTAX score, diabetes status, and clinical complexity to guide the CABG vs PCI decision by the Heart Team.

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