At 5 years of fol- low-up, MACCE rates did not differ significantly between groups of patients with low or intermediate SYNTAX scores, but significantly more patients in the DES group with high Table 4. Recommendations for CAD Revascularization to Improve Survival 2012 Recommendation 2014 Focused Update Recommendations Comments Class IIa Class I CABG is probably recommended in preference to PCI to improve survival in patients with multivessel CAD and diabetes mellitus, particularly if a LIMA graft can be anastomosed to the LAD artery.58 65 (Level of Evidence: B) A Heart Team approach to revascularization is recommended in patients with diabetes mellitus and complex multivessel CAD.66 (Level of Evidence: C) New recommendation CABG is generally recommended in preference to PCI to improve survival in patients with diabetes mellitus and multivessel CAD for which revascularization is likely to improve survival (3-vessel CAD or complex 2-vessel CAD involving the proximal LAD), particularly if a LIMA graft can be anastomosed to the LAD artery, provided the patient is a good candidate for surgery.58 69 (Level of Evidence: B) Modified recommendation (Class of Recommendation changed from IIa to I, wording modified, additional RCT added). CABG indicates coronary artery bypass graft; CAD, coronary artery disease; LAD, left anterior descending; LIMA, left internal mammary artery; PCI, percutaneous coronary intervention; and RCT, randomized controlled trial. SYNTAX scores had MACCE than in the CABG group In the LE MANS (Study of Unprotected Left Main Stenting Versus Bypass Surgery) trial,87 105 patients with left main CAD were randomized to receive PCI or CABG. Although a low proportion of patients treated with PCI received DES (35%) and a low proportion of patients treated with CABG received internal mammary grafts (72%), the outcomes at 30 days and 1 year were similar between the groups. 