skip to main content

SGLT2i Continuation on Dialysis — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardHeart FailureSGLT2i Continuation on DialysisEECC

Angiography shows an intermediate, short ostial left-main lesion in a patient with otherwise unobstructed coronary arteries. Pressure-wire assessment is technically unreliable because of guide damping. IVUS shows a reproducible minimum lumen area of 7.1 mm². What is the best next step?

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

Reveal the answer and explanation

Correct answer: D — Deferral with structured left-main clinical and imaging surveillance

The best answer is “Deferral with structured left-main clinical and imaging surveillance”. For an isolated ambiguous left-main lesion, an IVUS minimum lumen area at or above the validated deferral range of about 6 mm² supports safe deferral when the clinical picture is concordant. “Proceed directly to left-main PCI because any ostial lesion is high risk” is less appropriate because an angiographic intermediate lesion is not automatically functionally significant “Refer for CABG because IVUS cannot assess left-main severity” is less appropriate because IVUS is an accepted method for resolving ambiguous left-main anatomy “Repeat angiography yearly and prescribe dual antiplatelet therapy indefinitely” is less appropriate because surveillance does not require indefinite dual antiplatelet therapy without PCI or ACS “Use coronary calcium scoring to decide whether the left main is obstructive” is less appropriate because calcium scoring cannot determine the lumen significance of a specific ostial lesion

Reference: 2024 ESC Guidelines for chronic coronary syndromes. https://academic.oup.com/eurheartj/article/45/36/3415/7743115