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Three-Vessel CAD — RACP Adult Medicine MCQ

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ModerateCardiologyThree-Vessel CADRACP Adult Medicine

A 68-year-old man with chronic stable angina on maximally tolerated medical therapy (beta-blocker, calcium channel blocker, long-acting nitrate) continues to have exertional angina. Coronary angiography shows significant three-vessel disease with a SYNTAX score of 35. LVEF is 50%. What is the recommended revascularisation strategy?

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Correct answer: A — CABG surgery

For three-vessel coronary disease with a high SYNTAX score (>32), CABG provides superior long-term outcomes compared to PCI, including reduced mortality and repeat revascularisation (SYNTAX trial, 10-year data). The survival benefit of CABG is most pronounced in patients with diabetes, complex anatomy, and reduced LVEF. Heart team discussion is essential.

Reference: NHF/CSANZ – 2025 – ACS Guideline; ESC – 2024 – Chronic Coronary Syndromes Guidelines