ABIM INTERVENTIONAL CARDIOLOGY CERTIFICATION EXAMINATION PRACTICE
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A
Section 1: Case Selection and Management (Questions 1–20)
Question 1
A 62-year-old man presents with stable angina and a positive stress test. Coronary angiography reveals a
single 75% stenosis in the mid-LAD. FFR is performed and measures 0.82. What is the most appropriate
management?
A. Proceed with PCI of the LAD lesion
B. Continue medical therapy alone
C. Refer for CABG
D. Repeat FFR with adenosine
Correct Answer: B
Rationale: An FFR value >0.80 indicates that the stenosis is not hemodynamically significant. Current
guidelines recommend deferring PCI for lesions with FFR >0.80, as medical therapy alone is associated
with equivalent or better outcomes. The FAME trial established 0.80 as the threshold for
revascularization, and subsequent guidelines have adopted this cutoff.
Question 2
Which of the following is the most common indication for percutaneous coronary intervention (PCI)?
A. Stable angina refractory to medical therapy
B. Acute ST-segment elevation myocardial infarction (STEMI)
C. Chronic total occlusion
D. Silent ischemia
Correct Answer: B
Rationale: Acute STEMI is the most common and most time-sensitive indication for primary PCI.
Primary PCI is the preferred reperfusion strategy for STEMI when available within the recommended
time frame (within 120 minutes of first medical contact). The benefit of PCI in STEMI is well-established
and superior to fibrinolysis when delivered promptly.
Question 3
A 75-year-old woman with severe aortic stenosis (valve area 0.7 cm², mean gradient 45 mmHg) and
,NYHA Class III symptoms is being evaluated for TAVR. Which of the following is a contraindication to
TAVR?
A. Porcelain aorta
B. Severe COPD
C. Life expectancy <12 months
D. Prior CABG
Correct Answer: C
Rationale: Life expectancy of less than 12 months is considered a contraindication to TAVR, as the
patient is unlikely to derive meaningful benefit from the procedure. Porcelain aorta, severe COPD, and
prior CABG are not contraindications; in fact, they may favor TAVR over surgical AVR in appropriately
selected patients.
Question 4
A patient with NSTEMI is scheduled for an early invasive strategy. According to current guidelines, within
what time frame should coronary angiography be performed for a high-risk NSTEMI patient?
A. Within 2 hours
B. Within 24 hours
C. Within 72 hours
D. Within 7 days
Correct Answer: B
Rationale: The 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline recommends an early invasive
strategy (coronary angiography within 24 hours) for high-risk NSTEMI patients, including those with
elevated troponin, dynamic ECG changes, or hemodynamic instability. Immediate angiography (within 2
hours) is reserved for patients with cardiogenic shock or refractory ischemia.
Question 5
A 58-year-old man with diabetes and multivessel CAD (SYNTAX score 28) is being considered for
revascularization. What is the preferred revascularization strategy?
A. PCI with drug-eluting stents
B. CABG
C. Medical therapy alone
D. Hybrid revascularization
Correct Answer: B
Rationale: For patients with diabetes and multivessel CAD, CABG is generally preferred over PCI,
especially when the SYNTAX score is intermediate or high (≥23). The FREEDOM trial demonstrated
,superior outcomes with CABG compared to PCI with drug-eluting stents in diabetic patients with
multivessel disease.
Question 6
Which of the following is a Class I indication for primary PCI in STEMI?
A. Symptom onset >12 hours with no ongoing ischemia
B. Cardiogenic shock within 36 hours of symptom onset
C. STEMI with a contraindication to fibrinolysis
D. All of the above
Correct Answer: B
Rationale: Primary PCI is a Class I indication for STEMI patients with cardiogenic shock or acute
severe heart failure, regardless of time from symptom onset. For patients presenting >12 hours after
symptom onset without ongoing ischemia, primary PCI is not routinely indicated. STEMI with a
contraindication to fibrinolysis is also a Class I indication for primary PCI.
Question 7
A patient with stable ischemic heart disease and a proximal LAD stenosis of 90% is being evaluated. FFR
is not performed. What is the most appropriate management?
A. Medical therapy alone
B. PCI with drug-eluting stent
C. CABG
D. Continue medical therapy and repeat angiography in 1 year
Correct Answer: B
Rationale: For patients with stable ischemic heart disease and high-risk anatomy (such as a proximal
LAD stenosis ≥90%), revascularization with PCI is generally recommended. FFR is not required when the
stenosis is visually severe (≥90%) because the hemodynamic significance is presumed.
Question 8
A 70-year-old woman with severe symptomatic aortic stenosis and a STS score of 8% is being evaluated.
What is the recommended treatment?
A. Medical therapy alone
B. Surgical aortic valve replacement (SAVR)
C. TAVR
D. Balloon aortic valvuloplasty
Correct Answer: C
, Rationale: For patients with severe symptomatic aortic stenosis and an intermediate or high surgical
risk (STS score ≥4% or ≥8%), TAVR is recommended over SAVR. The PARTNER and CoreValve trials
demonstrated that TAVR is non-inferior or superior to SAVR in intermediate- and high-risk patients.
Question 9
Which of the following is a contraindication to primary PCI in STEMI?
A. Severe thrombocytopenia (platelet count <50,000)
B. Advanced age (>80 years)
C. Renal insufficiency
D. Cardiogenic shock
Correct Answer: A
Rationale: Severe thrombocytopenia (platelet count <50,000) is a relative contraindication to
primary PCI due to the high risk of bleeding and the need for antiplatelet and anticoagulant therapy.
Advanced age, renal insufficiency, and cardiogenic shock are not contraindications; in fact, these
patients may derive the greatest benefit from primary PCI.
Question 10
A patient with STEMI presents to a non-PCI-capable hospital. The nearest PCI center is 90 minutes away.
What is the most appropriate reperfusion strategy?
A. Transfer for primary PCI within 120 minutes
B. Administer fibrinolytic therapy immediately
C. Transfer for primary PCI regardless of time
D. Administer fibrinolytic therapy and transfer for rescue PCI
Correct Answer: A
Rationale: For STEMI patients presenting to a non-PCI-capable hospital, transfer for primary PCI is
recommended if the expected door-to-balloon time is ≤120 minutes. If transfer time exceeds 120
minutes, fibrinolytic therapy should be administered within 30 minutes of presentation, followed by
transfer for rescue or routine early PCI.
Question 11
What is the recommended door-to-balloon time for primary PCI in STEMI?
A. ≤60 minutes
B. ≤90 minutes
C. ≤120 minutes
D. ≤180 minutes
Correct Answer: B
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A
Section 1: Case Selection and Management (Questions 1–20)
Question 1
A 62-year-old man presents with stable angina and a positive stress test. Coronary angiography reveals a
single 75% stenosis in the mid-LAD. FFR is performed and measures 0.82. What is the most appropriate
management?
A. Proceed with PCI of the LAD lesion
B. Continue medical therapy alone
C. Refer for CABG
D. Repeat FFR with adenosine
Correct Answer: B
Rationale: An FFR value >0.80 indicates that the stenosis is not hemodynamically significant. Current
guidelines recommend deferring PCI for lesions with FFR >0.80, as medical therapy alone is associated
with equivalent or better outcomes. The FAME trial established 0.80 as the threshold for
revascularization, and subsequent guidelines have adopted this cutoff.
Question 2
Which of the following is the most common indication for percutaneous coronary intervention (PCI)?
A. Stable angina refractory to medical therapy
B. Acute ST-segment elevation myocardial infarction (STEMI)
C. Chronic total occlusion
D. Silent ischemia
Correct Answer: B
Rationale: Acute STEMI is the most common and most time-sensitive indication for primary PCI.
Primary PCI is the preferred reperfusion strategy for STEMI when available within the recommended
time frame (within 120 minutes of first medical contact). The benefit of PCI in STEMI is well-established
and superior to fibrinolysis when delivered promptly.
Question 3
A 75-year-old woman with severe aortic stenosis (valve area 0.7 cm², mean gradient 45 mmHg) and
,NYHA Class III symptoms is being evaluated for TAVR. Which of the following is a contraindication to
TAVR?
A. Porcelain aorta
B. Severe COPD
C. Life expectancy <12 months
D. Prior CABG
Correct Answer: C
Rationale: Life expectancy of less than 12 months is considered a contraindication to TAVR, as the
patient is unlikely to derive meaningful benefit from the procedure. Porcelain aorta, severe COPD, and
prior CABG are not contraindications; in fact, they may favor TAVR over surgical AVR in appropriately
selected patients.
Question 4
A patient with NSTEMI is scheduled for an early invasive strategy. According to current guidelines, within
what time frame should coronary angiography be performed for a high-risk NSTEMI patient?
A. Within 2 hours
B. Within 24 hours
C. Within 72 hours
D. Within 7 days
Correct Answer: B
Rationale: The 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline recommends an early invasive
strategy (coronary angiography within 24 hours) for high-risk NSTEMI patients, including those with
elevated troponin, dynamic ECG changes, or hemodynamic instability. Immediate angiography (within 2
hours) is reserved for patients with cardiogenic shock or refractory ischemia.
Question 5
A 58-year-old man with diabetes and multivessel CAD (SYNTAX score 28) is being considered for
revascularization. What is the preferred revascularization strategy?
A. PCI with drug-eluting stents
B. CABG
C. Medical therapy alone
D. Hybrid revascularization
Correct Answer: B
Rationale: For patients with diabetes and multivessel CAD, CABG is generally preferred over PCI,
especially when the SYNTAX score is intermediate or high (≥23). The FREEDOM trial demonstrated
,superior outcomes with CABG compared to PCI with drug-eluting stents in diabetic patients with
multivessel disease.
Question 6
Which of the following is a Class I indication for primary PCI in STEMI?
A. Symptom onset >12 hours with no ongoing ischemia
B. Cardiogenic shock within 36 hours of symptom onset
C. STEMI with a contraindication to fibrinolysis
D. All of the above
Correct Answer: B
Rationale: Primary PCI is a Class I indication for STEMI patients with cardiogenic shock or acute
severe heart failure, regardless of time from symptom onset. For patients presenting >12 hours after
symptom onset without ongoing ischemia, primary PCI is not routinely indicated. STEMI with a
contraindication to fibrinolysis is also a Class I indication for primary PCI.
Question 7
A patient with stable ischemic heart disease and a proximal LAD stenosis of 90% is being evaluated. FFR
is not performed. What is the most appropriate management?
A. Medical therapy alone
B. PCI with drug-eluting stent
C. CABG
D. Continue medical therapy and repeat angiography in 1 year
Correct Answer: B
Rationale: For patients with stable ischemic heart disease and high-risk anatomy (such as a proximal
LAD stenosis ≥90%), revascularization with PCI is generally recommended. FFR is not required when the
stenosis is visually severe (≥90%) because the hemodynamic significance is presumed.
Question 8
A 70-year-old woman with severe symptomatic aortic stenosis and a STS score of 8% is being evaluated.
What is the recommended treatment?
A. Medical therapy alone
B. Surgical aortic valve replacement (SAVR)
C. TAVR
D. Balloon aortic valvuloplasty
Correct Answer: C
, Rationale: For patients with severe symptomatic aortic stenosis and an intermediate or high surgical
risk (STS score ≥4% or ≥8%), TAVR is recommended over SAVR. The PARTNER and CoreValve trials
demonstrated that TAVR is non-inferior or superior to SAVR in intermediate- and high-risk patients.
Question 9
Which of the following is a contraindication to primary PCI in STEMI?
A. Severe thrombocytopenia (platelet count <50,000)
B. Advanced age (>80 years)
C. Renal insufficiency
D. Cardiogenic shock
Correct Answer: A
Rationale: Severe thrombocytopenia (platelet count <50,000) is a relative contraindication to
primary PCI due to the high risk of bleeding and the need for antiplatelet and anticoagulant therapy.
Advanced age, renal insufficiency, and cardiogenic shock are not contraindications; in fact, these
patients may derive the greatest benefit from primary PCI.
Question 10
A patient with STEMI presents to a non-PCI-capable hospital. The nearest PCI center is 90 minutes away.
What is the most appropriate reperfusion strategy?
A. Transfer for primary PCI within 120 minutes
B. Administer fibrinolytic therapy immediately
C. Transfer for primary PCI regardless of time
D. Administer fibrinolytic therapy and transfer for rescue PCI
Correct Answer: A
Rationale: For STEMI patients presenting to a non-PCI-capable hospital, transfer for primary PCI is
recommended if the expected door-to-balloon time is ≤120 minutes. If transfer time exceeds 120
minutes, fibrinolytic therapy should be administered within 30 minutes of presentation, followed by
transfer for rescue or routine early PCI.
Question 11
What is the recommended door-to-balloon time for primary PCI in STEMI?
A. ≤60 minutes
B. ≤90 minutes
C. ≤120 minutes
D. ≤180 minutes
Correct Answer: B
