ABIM Interventional Cardiology Certification
Examination Questions And Correct Answers
(Verified Answers) Plus Rationale 2026 Q&A|
Instant Download Pdf.
The ABIM Interventional Cardiology Certification Exam evaluates knowledge across
several key domains. According to the official blueprint, the exam is composed of up
to 220 multiple-choice questions, with about 35 being new questions that do not count
toward the score . Most questions describe patient scenarios and ask about diagnosis,
test interpretation, treatment recommendations, and prognosis .
The primary content areas are Case Selection and Management (20%), Procedural
Techniques (20%), Catheter-Based Management of Noncoronary Disease (13%),
Pharmacology (12%), and Cardiac Imaging and Assessment (9%), among others .
Question 1:
A 68-year-old man with stable angina despite optimal medical therapy is referred for
coronary angiography. His coronary angiogram reveals a 60% diameter stenosis in the
proximal left anterior descending artery. Before proceeding with percutaneous coronary
intervention, what is the most appropriate next step to determine the functional
significance of this lesion?
A) Proceed directly with stent placement based on angiographic appearance
B) Perform intravascular ultrasound (IVUS) to assess minimum lumen area
C) Measure fractional flow reserve (FFR) across the lesion
D) Perform optical coherence tomography (OCT) to assess plaque morphology
Answer: C. Measure fractional flow reserve (FFR) across the lesion
FFR is the gold standard for assessing the functional significance of intermediate coronary
lesions (typically 40-70% stenosis). It helps determine whether the lesion is
hemodynamically significant and warrants revascularization. In patients with stable
,angina, PCI is indicated primarily for relief of refractory angina despite optimal medical
therapy, and FFR provides objective evidence of ischemia .
Question 2:
A 55-year-old man presents to the emergency department with acute onset of
substernal chest pain. The ECG shows 3 mm ST-segment elevation in leads V1-V4. The
patient is within 60 minutes of symptom onset. What is the recommended door-to-
balloon time for primary PCI in this patient?
A) 30 minutes
B) 60 minutes
C) 90 minutes
D) 120 minutes
Answer: C. 90 minutes
Guidelines recommend a door-to-balloon time of less than 90 minutes for patients with
STEMI undergoing primary PCI. Shorter times are associated with improved outcomes, and
systems of care should be organized to achieve this target consistently .
Question 3:
A 72-year-old man with severe symptomatic aortic stenosis is being evaluated for valve
replacement. He has a history of prior coronary artery bypass grafting, chronic
obstructive pulmonary disease, and a Society of Thoracic Surgeons (STS) risk score of
8%. What is the most appropriate treatment recommendation?
A) Surgical aortic valve replacement
B) Transcatheter aortic valve replacement (TAVR)
C) Medical management with close follow-up
D) Balloon aortic valvuloplasty
Answer: B. Transcatheter aortic valve replacement (TAVR)
TAVR is indicated for patients with severe symptomatic aortic stenosis who are at high or
prohibitive surgical risk. An STS risk score of 8% indicates high surgical risk. TAVR has
been shown to be non-inferior or superior to surgical AVR in this population. Balloon
aortic valvuloplasty is generally a palliative or bridge procedure .
,Question 4:
A 62-year-old man with non-ST-elevation acute coronary syndrome (NSTE-ACS) is
undergoing cardiac catheterization via the right radial artery. Prior to sheath insertion,
the Allen's test is performed and is abnormal. What is the appropriate next step?
A) Proceed with right radial access as planned
B) Perform left radial access instead
C) Use femoral artery access
D) Obtain a Doppler ultrasound of the hand
Answer: C. Use femoral artery access
A negative or abnormal Allen's test suggests poor collateral circulation to the hand via the
ulnar artery, which increases the risk of hand ischemia with radial artery access. In such
cases, alternative access sites such as the femoral artery should be considered .
Question 5:
A 58-year-old man with a drug-eluting stent placed in the left anterior descending
artery 6 months ago presents with recurrent chest pain. Coronary angiography shows
in-stent restenosis at the proximal edge of the stent. What is the primary mechanism of
restenosis after balloon angioplasty and stenting?
A) Acute stent thrombosis
B) Elastic recoil
C) Neointimal hyperplasia
D) Vessel remodeling
Answer: C. Neointimal hyperplasia
Neointimal hyperplasia is the primary mechanism of in-stent restenosis. It results from
smooth muscle cell proliferation and migration, along with extracellular matrix deposition
within the stent. Drug-eluting stents were developed to reduce neointimal hyperplasia and
lower restenosis rates .
, Question 6:
A 45-year-old man undergoes elective PCI with a drug-eluting stent to the right
coronary artery. He is not on chronic antiplatelet therapy prior to the procedure. What is
the most appropriate antiplatelet regimen to administer before or during the
procedure?
A) Aspirin alone
B) Clopidogrel alone
C) Aspirin plus clopidogrel
D) Warfarin alone
Answer: C. Aspirin plus clopidogrel
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (such as clopidogrel) is the
standard of care before elective PCI with drug-eluting stent placement. This combination
reduces the risk of stent thrombosis. Aspirin should be continued indefinitely, and
clopidogrel is typically continued for 6-12 months depending on the stent type and patient
factors .
Question 7:
A 70-year-old woman with a history of prior intracranial hemorrhage presents with an
acute STEMI. She is within 3 hours of symptom onset and is not near a PCI-capable
facility. Which of the following is an absolute contraindication to fibrinolytic therapy in
this patient?
A) Age >75 years
B) History of peptic ulcer disease
C) Prior intracranial hemorrhage
D) Systolic blood pressure >180 mmHg
Answer: C. Prior intracranial hemorrhage
Prior intracranial hemorrhage is an absolute contraindication to fibrinolytic therapy due to
the unacceptably high risk of recurrent intracranial bleeding. Other absolute
contraindications include known intracranial neoplasm, arteriovenous malformation, or
aneurysm, and suspected aortic dissection .
Examination Questions And Correct Answers
(Verified Answers) Plus Rationale 2026 Q&A|
Instant Download Pdf.
The ABIM Interventional Cardiology Certification Exam evaluates knowledge across
several key domains. According to the official blueprint, the exam is composed of up
to 220 multiple-choice questions, with about 35 being new questions that do not count
toward the score . Most questions describe patient scenarios and ask about diagnosis,
test interpretation, treatment recommendations, and prognosis .
The primary content areas are Case Selection and Management (20%), Procedural
Techniques (20%), Catheter-Based Management of Noncoronary Disease (13%),
Pharmacology (12%), and Cardiac Imaging and Assessment (9%), among others .
Question 1:
A 68-year-old man with stable angina despite optimal medical therapy is referred for
coronary angiography. His coronary angiogram reveals a 60% diameter stenosis in the
proximal left anterior descending artery. Before proceeding with percutaneous coronary
intervention, what is the most appropriate next step to determine the functional
significance of this lesion?
A) Proceed directly with stent placement based on angiographic appearance
B) Perform intravascular ultrasound (IVUS) to assess minimum lumen area
C) Measure fractional flow reserve (FFR) across the lesion
D) Perform optical coherence tomography (OCT) to assess plaque morphology
Answer: C. Measure fractional flow reserve (FFR) across the lesion
FFR is the gold standard for assessing the functional significance of intermediate coronary
lesions (typically 40-70% stenosis). It helps determine whether the lesion is
hemodynamically significant and warrants revascularization. In patients with stable
,angina, PCI is indicated primarily for relief of refractory angina despite optimal medical
therapy, and FFR provides objective evidence of ischemia .
Question 2:
A 55-year-old man presents to the emergency department with acute onset of
substernal chest pain. The ECG shows 3 mm ST-segment elevation in leads V1-V4. The
patient is within 60 minutes of symptom onset. What is the recommended door-to-
balloon time for primary PCI in this patient?
A) 30 minutes
B) 60 minutes
C) 90 minutes
D) 120 minutes
Answer: C. 90 minutes
Guidelines recommend a door-to-balloon time of less than 90 minutes for patients with
STEMI undergoing primary PCI. Shorter times are associated with improved outcomes, and
systems of care should be organized to achieve this target consistently .
Question 3:
A 72-year-old man with severe symptomatic aortic stenosis is being evaluated for valve
replacement. He has a history of prior coronary artery bypass grafting, chronic
obstructive pulmonary disease, and a Society of Thoracic Surgeons (STS) risk score of
8%. What is the most appropriate treatment recommendation?
A) Surgical aortic valve replacement
B) Transcatheter aortic valve replacement (TAVR)
C) Medical management with close follow-up
D) Balloon aortic valvuloplasty
Answer: B. Transcatheter aortic valve replacement (TAVR)
TAVR is indicated for patients with severe symptomatic aortic stenosis who are at high or
prohibitive surgical risk. An STS risk score of 8% indicates high surgical risk. TAVR has
been shown to be non-inferior or superior to surgical AVR in this population. Balloon
aortic valvuloplasty is generally a palliative or bridge procedure .
,Question 4:
A 62-year-old man with non-ST-elevation acute coronary syndrome (NSTE-ACS) is
undergoing cardiac catheterization via the right radial artery. Prior to sheath insertion,
the Allen's test is performed and is abnormal. What is the appropriate next step?
A) Proceed with right radial access as planned
B) Perform left radial access instead
C) Use femoral artery access
D) Obtain a Doppler ultrasound of the hand
Answer: C. Use femoral artery access
A negative or abnormal Allen's test suggests poor collateral circulation to the hand via the
ulnar artery, which increases the risk of hand ischemia with radial artery access. In such
cases, alternative access sites such as the femoral artery should be considered .
Question 5:
A 58-year-old man with a drug-eluting stent placed in the left anterior descending
artery 6 months ago presents with recurrent chest pain. Coronary angiography shows
in-stent restenosis at the proximal edge of the stent. What is the primary mechanism of
restenosis after balloon angioplasty and stenting?
A) Acute stent thrombosis
B) Elastic recoil
C) Neointimal hyperplasia
D) Vessel remodeling
Answer: C. Neointimal hyperplasia
Neointimal hyperplasia is the primary mechanism of in-stent restenosis. It results from
smooth muscle cell proliferation and migration, along with extracellular matrix deposition
within the stent. Drug-eluting stents were developed to reduce neointimal hyperplasia and
lower restenosis rates .
, Question 6:
A 45-year-old man undergoes elective PCI with a drug-eluting stent to the right
coronary artery. He is not on chronic antiplatelet therapy prior to the procedure. What is
the most appropriate antiplatelet regimen to administer before or during the
procedure?
A) Aspirin alone
B) Clopidogrel alone
C) Aspirin plus clopidogrel
D) Warfarin alone
Answer: C. Aspirin plus clopidogrel
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (such as clopidogrel) is the
standard of care before elective PCI with drug-eluting stent placement. This combination
reduces the risk of stent thrombosis. Aspirin should be continued indefinitely, and
clopidogrel is typically continued for 6-12 months depending on the stent type and patient
factors .
Question 7:
A 70-year-old woman with a history of prior intracranial hemorrhage presents with an
acute STEMI. She is within 3 hours of symptom onset and is not near a PCI-capable
facility. Which of the following is an absolute contraindication to fibrinolytic therapy in
this patient?
A) Age >75 years
B) History of peptic ulcer disease
C) Prior intracranial hemorrhage
D) Systolic blood pressure >180 mmHg
Answer: C. Prior intracranial hemorrhage
Prior intracranial hemorrhage is an absolute contraindication to fibrinolytic therapy due to
the unacceptably high risk of recurrent intracranial bleeding. Other absolute
contraindications include known intracranial neoplasm, arteriovenous malformation, or
aneurysm, and suspected aortic dissection .
