American Board of Internal Medicine (ABIM) Certification Practice Exam

What method is used to determine the appropriateness of revascularization in patients with acute coronary syndrome?

1. Left heart catheterization

2. Fractional flow reserve (FFR)

3. Electrophysiology studies

4. Coronary angiography alone

The correct answer is: Fractional flow reserve (FFR)

The determination of the appropriateness of revascularization in patients with acute coronary syndrome often involves the use of fractional flow reserve (FFR). FFR is a specific physiological measurement that assesses the significance of coronary artery stenoses by measuring the pressure differences across a coronary lesion during hyperemia. By using FFR, clinicians can determine if a specific coronary artery blockage is causing significant ischemia and thus warrants revascularization. An FFR value of 0.80 or below typically indicates that the stenosis is functionally significant, suggesting that revascularization would likely benefit the patient in terms of improving blood flow and reducing symptoms or risks related to myocardial ischemia. While left heart catheterization and coronary angiography are integral components in evaluating coronary anatomy and understanding the extent of disease, these methods do not provide functional information about the impact of the blockage on myocardial perfusion. Therefore, they cannot decisively determine whether revascularization is warranted based solely on anatomical imagery. Electrophysiology studies are not utilized for assessing coronary artery disease but rather for evaluating arrhythmias, making them irrelevant in this context. Thus, fractional flow reserve represents a more relevant and precise method in deciding the necessity for revascularization in patients experiencing acute coronary syndrome, allowing more