American Board of Internal Medicine (ABIM) Certification Practice Exam

After treating the culprit artery in acute coronary syndrome, what should be assessed regarding non-culprit artery lesions?

1. Left ventricular function

2. Fractional flow reserve

3. Patient's exercise tolerance

4. Family history of CAD

The correct answer is: Fractional flow reserve

Assessing fractional flow reserve (FFR) after treating the culprit artery in acute coronary syndrome is critical because it helps determine the hemodynamic significance of any non-culprit artery lesions. FFR is a pivotal measurement used during coronary angiography to evaluate if a specific artery significantly restricts blood flow to the heart muscle. When a patient presents with acute coronary syndrome, particularly with a culprit lesion requiring intervention, non-culprit arteries may harbor lesions that are not immediately addressed. However, these lesions could still pose a risk for future events if they are significant enough to impair blood flow. By measuring the FFR, clinicians can ascertain whether these non-culprit lesions are likely to cause ischemia and warrant further intervention such as angioplasty or stenting. In contrast, evaluating left ventricular function, while important in overall cardiac assessment, does not directly inform the status of non-culprit arteries. Similarly, assessing the patient's exercise tolerance primarily provides insight into functional capacity but does not reflect the hemodynamic impact of non-culprit lesions. Lastly, understanding the family history of coronary artery disease does not impact the immediate management of non-culprit lesions post-acute event, as it serves more to guide long-term risk assessment and prevention strategies rather