CABG is considered when coronary vessels are unsuitable for PCI.

• A. Coronary vessels are unsuitable for PCI
• B. PCI is always preferred over CABG
• C. There is no CAD
• D. The patient refuses all treatment

Answer: (A)

The choice between CABG and PCI hinges on whether the coronary anatomy can be effectively treated with catheter-based approaches. When the vessels are unsuitable for PCI—such as with complex multivessel disease, left main disease, diffuse or heavily calcified lesions, very small distal vessels, or chronic total occlusions—CABG is considered because bypass grafts can restore blood flow around those problematic segments and often provide more durable revascularization. If there is no coronary artery disease, revascularization isn’t needed, and PCI isn’t indicated by default. Saying PCI is always preferred ignores the limitations of anatomy, and a patient’s preference or other nonclinical factors don’t establish a clinical indication for CABG.