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Chronic Coronary Syndrome — EECC MCQ

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HardCoronary Artery DiseaseChronic Coronary SyndromeEECC

A 70-year-old man with stable angina (CCS class II) undergoes coronary angiography which shows a 75% stenosis of the proximal LAD and 60% stenosis of the mid-circumflex artery. His LVEF is 55%. He has well-controlled hypertension and type 2 diabetes. Fractional flow reserve of the LAD is 0.72 and the circumflex artery is 0.83. His SYNTAX score is 18. What is the most appropriate revascularisation strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — PCI to the LAD only

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

Per the 2024 ESC CCS Guidelines, revascularisation should be guided by FFR, with a threshold of 0.80 or below indicating haemodynamic significance. The LAD lesion has an FFR of 0.72 (significant), whereas the circumflex lesion has an FFR of 0.83 (not significant). Only the LAD requires revascularisation. With a low SYNTAX score (22 or below), PCI is appropriate. PCI to both vessels (B) is inappropriate as the circumflex is not haemodynamically significant. CABG (C) would be considered with higher SYNTAX scores or three-vessel disease. OMT alone (D) is inferior for a significant proximal LAD lesion causing symptoms. PCI to circumflex only (E) treats a non-significant lesion.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes