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Three-vessel CAD — EECC MCQ

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HardCoronary Artery DiseaseThree-vessel CADEECC

A 63-year-old man with diabetes and CKD stage 3b (eGFR 38 mL/min/1.73 m2) has stable three-vessel coronary artery disease with a SYNTAX score of 34. His LVEF is 40%. He is reviewed by the Heart Team. Which revascularisation strategy is most appropriate?

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Reveal the answer and explanation

Correct answer: B — Coronary artery bypass grafting with left internal mammary artery graft to the LAD

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

Per the 2024 ESC CCS Guidelines, CABG is recommended over PCI for patients with three-vessel disease and a SYNTAX score above 22, particularly in the presence of diabetes and reduced LVEF (Class I). The LIMA-to-LAD graft is the cornerstone of CABG. PCI to three vessels (A) is inferior in this high-SYNTAX, diabetic context (SYNTAX, FREEDOM trials). A hybrid approach (C) is not standard. Medical therapy alone (D) is inferior in three-vessel disease with reduced LVEF. LAD-only PCI (E) leaves significant residual ischaemic burden.

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