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Refractory Angina PCI — RACP Adult Medicine MCQ

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ModerateCardiologyRefractory Angina PCIRACP Adult Medicine

A 60-year-old woman with stable angina (CCS class II) on maximal anti-anginal therapy (bisoprolol 10 mg, amlodipine 10 mg, isosorbide mononitrate 60 mg, nicorandil 10 mg BD) continues to have exertional angina 3× per week. Stress MRI shows inducible ischaemia in LAD territory. Coronary angiography shows a proximal LAD 85% stenosis, other vessels <50%. SYNTAX score is 5. What is the most appropriate management?

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Correct answer: E — PCI to LAD

Refractory angina despite optimal medical therapy with significant proximal LAD stenosis and inducible ischaemia — PCI is appropriate. For isolated proximal LAD disease with low SYNTAX score, PCI with DES produces excellent outcomes (MASS-II, FAME-2: PCI + OMT superior to OMT alone for FFR-significant lesions in reducing urgent revascularisation). CABG with LIMA-LAD is an alternative with better long-term patency but higher procedural invasiveness. For single-vessel proximal LAD, PCI and CABG have similar outcomes.

Reference: CSANZ – 2025 – Revascularisation; ESC 2024 CCS; FAME-2 Trial