Coronary Artery Disease USMLE Step 1 Practice Question
A 68-year-old man with a 5-year history of stable angina presents for evaluation of chest pain that occurs with exertion and is relieved by rest. His symptoms are well-controlled on atenolol, lisinopril, atorvastatin, and sublingual nitroglycerin as needed. Coronary angiography reveals 75% stenosis of the left anterior descending artery and 80% stenosis of the left circumflex artery, with no significant left main coronary disease. His left ventricular ejection fraction is 50%. Stress testing demonstrates moderate, reversible ischemia in the distribution of both diseased vessels. Which of the following is the most appropriate next step in management?
Answer choices
- APercutaneous coronary intervention of the left anterior descending artery only, deferring treatment of the left circumflex lesion
- BCoronary artery bypass grafting, as multivessel disease always requires surgical revascularization
- CImmediate revascularization of both vessels, as the degree of stenosis mandates intervention regardless of symptom severity
- DPercutaneous coronary intervention of both vessels as the preferred initial strategy due to lower procedural risk compared to bypass surgery
- EContinuation of optimal medical therapy with consideration of revascularization only if symptoms become refractory to medical managementCorrect answer
- FIntra-aortic balloon pump insertion followed by urgent revascularization due to multivessel disease and reduced ejection fraction
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