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PCI vs CABG Low SYNTAX — RACP Adult Medicine MCQ

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ModerateCardiologyPCI vs CABG Low SYNTAXRACP Adult Medicine

A 55-year-old woman with stable angina and three-vessel coronary artery disease (LAD proximal 80%, LCx 70%, RCA 75%) with preserved LVEF (55%) and a SYNTAX score of 15 (low complexity) is being considered for revascularisation. She has no diabetes. She prefers a less invasive approach. What is the most appropriate revascularisation strategy?

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

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Correct answer: B — PCI with drug-eluting stents

Three-vessel CAD with low SYNTAX score (≤22), preserved LVEF, and no diabetes — PCI with DES is a reasonable alternative to CABG per ESC 2024 revascularisation guidelines (SYNTAX trial: PCI non-inferior to CABG for low SYNTAX scores at 5 years). For high SYNTAX scores (≥33), left main disease, or diabetes with MVD, CABG is preferred (FREEDOM trial: CABG superior to PCI in diabetic MVD). Shared decision-making with Heart Team is essential.

Reference: CSANZ – 2025 – Revascularisation; ESC 2024; SYNTAX/FREEDOM Trials