CABG for Complex MVD Diabetes — RACP Adult Medicine MCQ

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EasyCardiologyCABG for Complex MVD DiabetesRACP Adult Medicine

A 65-year-old man with diabetes and three-vessel CAD (SYNTAX score 35 — high complexity) including proximal LAD disease and LVEF 40% is being assessed for revascularisation. He has good surgical risk. What is the preferred revascularisation strategy?

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Correct answer: C — CABG

Three-vessel CAD with high SYNTAX score (≥33), diabetes, proximal LAD disease, and reduced LVEF — CABG is the preferred strategy. Evidence: SYNTAX (CABG superior for high SYNTAX), FREEDOM (CABG superior in diabetic MVD), and ART (bilateral IMA grafts improve long-term outcomes). CABG with LIMA-LAD provides durable revascularisation (LIMA patency >90% at 10 years). CABG also reduces all-cause mortality in patients with LVEF <40% compared to PCI (REVIVED-BCIS2 showed no benefit of PCI over OMT in ischaemic cardiomyopathy).

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