100+ Free ABIM Interventional Cardiology Practice Questions

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Question 1

Score: 0/0

A 62-year-old man with stable angina has a 70% mid-LAD stenosis on coronary angiography. Which fractional flow reserve (FFR) value is the threshold below which PCI is indicated based on FAME and FAME 2?

FFR ≤ 0.90

FFR ≤ 0.85

FFR ≤ 0.80

FFR ≤ 0.75

to track

2026 Statistics

Key Facts: ABIM Interventional Cardiology Exam

~200

Exam Questions

ABIM 2026

~10 hours

Exam Day Length

ABIM 2026

~$2,990

Application + Exam Fee

ABIM 2026

~90-93%

First-Attempt Pass Rate

ABIM Assessment Results

1 year

IC Fellowship Required

ACGME

5-yr LKA

MOC Option

ABIM MOC

The ABIM Interventional Cardiology subspecialty exam certifies cardiologists to perform percutaneous coronary and peripheral interventions, and increasingly to participate in structural heart programs. It consists of approximately 200 single-best-answer MCQs administered across four ~2-hour modules over a single ~10-hour test day at Pearson VUE. The application plus exam fee is approximately $2,990. Eligibility requires active ABIM Cardiovascular Disease certification plus satisfactory completion of a 1-year ACGME-accredited Interventional Cardiology fellowship. The 2026 blueprint emphasizes case selection (ISCHEMIA, COURAGE, SYNTAX/SYNTAX II), invasive physiology (FFR ≤0.80, iFR ≤0.89, CFR, IMR), IVUS/OCT stent optimization (MSA ≥5.5 mm² or ≥90% distal reference), STEMI primary PCI timing, complex PCI (left main EXCEL/NOBLE, CTO hybrid algorithm, bifurcation MADS classification, rotational/orbital atherectomy and Shockwave IVL), antithrombotic therapy (DAPT duration, ARC-HBR short DAPT, TOPIC/TWILIGHT de-escalation), and structural heart basics (TAVR, MitraClip COAPT, Watchman FLX). Once certified, diplomates maintain certification via the Longitudinal Knowledge Assessment (LKA) or 10-year recertification exam.

Sample ABIM Interventional Cardiology Practice Questions

Try these sample questions to test your ABIM Interventional Cardiology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old man with stable angina has a 70% mid-LAD stenosis on coronary angiography. Which fractional flow reserve (FFR) value is the threshold below which PCI is indicated based on FAME and FAME 2?

A.FFR ≤ 0.90

B.FFR ≤ 0.85

C.FFR ≤ 0.80

D.FFR ≤ 0.75

Explanation: FFR ≤ 0.80 defines hemodynamically significant ischemia and was the threshold used in the FAME and FAME 2 trials to guide PCI. Values between 0.81-0.90 are typically deferred with medical therapy. The 0.75-0.80 zone is a gray area but guidelines use 0.80 as the action cutoff.

2Which instantaneous wave-free ratio (iFR) value corresponds to the ischemic threshold (DEFINE-FLAIR, iFR-SWEDEHEART)?

A.iFR ≤ 0.95

B.iFR ≤ 0.89

C.iFR ≤ 0.80

D.iFR ≤ 0.75

Explanation: iFR ≤ 0.89 is the accepted threshold for hemodynamically significant ischemia. It is measured during the wave-free period of diastole and does not require hyperemia (no adenosine). DEFINE-FLAIR and iFR-SWEDEHEART showed non-inferiority to FFR using this cutoff.

3A patient presents with STEMI to a non-PCI hospital. Expected transfer time to a PCI-capable center is 180 minutes. What is the recommended reperfusion strategy?

A.Transfer for primary PCI regardless of delay

B.Administer fibrinolytic therapy (if no contraindications) and transfer for early angiography (pharmacoinvasive)

C.Medical management only with aspirin and heparin

D.Delay reperfusion until cardiogenic shock develops

Explanation: When first medical contact-to-device time is expected to exceed 120 minutes, fibrinolytic therapy should be given within 30 minutes (if no contraindications), followed by transfer for routine coronary angiography within 3-24 hours — the pharmacoinvasive strategy. Primary PCI is preferred only if the 120-minute FMC-to-device goal can be met.

4What is the recommended door-to-balloon (D2B) time goal for primary PCI in STEMI at a PCI-capable hospital?

A.≤ 30 minutes

B.≤ 60 minutes

C.≤ 90 minutes

D.≤ 120 minutes

Explanation: For patients presenting to a PCI-capable hospital, the D2B time goal is ≤ 90 minutes. For transfer patients, the first medical contact-to-device time goal is ≤ 120 minutes. These benchmarks are class I recommendations in ACC/AHA STEMI guidelines and are tracked as CMS/ACC quality measures.

5Which view is best for visualizing the proximal LAD and the LAD-diagonal bifurcation?

A.RAO caudal

B.LAO cranial

C.RAO cranial

D.LAO caudal (spider view)

Explanation: The RAO cranial view best displays the proximal and mid LAD along its length and the LAD-diagonal bifurcation. The LAO caudal (spider) view shows the left main bifurcation. RAO caudal shows the LCX and obtuse marginals. LAO cranial shows the mid-distal RCA.

6Which angiographic view is known as the 'spider view' and best displays the left main bifurcation, ostial LAD, and ostial LCX?

A.LAO caudal

B.RAO caudal

C.LAO cranial

D.AP cranial

Explanation: The LAO caudal view is the 'spider view' and is optimal for assessing the left main bifurcation, including the distal left main, ostial LAD, ostial LCX, and ramus intermedius. It is essential for left main PCI planning.

7In a right-dominant coronary system, which artery gives rise to the posterior descending artery (PDA)?

A.Left circumflex

B.Left anterior descending

C.Right coronary artery

D.Ramus intermedius

Explanation: In right dominance (~85% of patients), the PDA arises from the distal RCA. In left dominance (~7%), the PDA arises from the LCX. In co-dominance (~8%), both RCA and LCX contribute. Dominance is defined by the vessel supplying the PDA.

8A collateral vessel is seen filling the distal segment of a CTO. The distal vessel fills completely but with delayed filling compared to the donor vessel. What is the Rentrop grade?

A.Rentrop 0

B.Rentrop 1

C.Rentrop 2

D.Rentrop 3

Explanation: Rentrop grading: 0 = no filling, 1 = filling of side branches only without distal epicardial filling, 2 = partial filling of the epicardial vessel, 3 = complete filling of the epicardial vessel (even if delayed). Complete distal filling = Rentrop 3.

9What TIMI flow grade describes contrast that passes through the stenosis but clears slowly from the distal bed?

A.TIMI 0

B.TIMI 1

C.TIMI 2

D.TIMI 3

Explanation: TIMI 0 = no perfusion, TIMI 1 = contrast penetrates obstruction without distal perfusion, TIMI 2 = complete but delayed perfusion distally (slow filling/clearing), TIMI 3 = normal brisk flow and clearance. Slow distal clearance indicates TIMI 2.

10A corrected TIMI frame count (cTFC) of 40 indicates what?

A.Faster-than-normal flow

B.Normal flow (cTFC < 21)

C.Slow flow suggesting microvascular dysfunction or no-reflow

D.TIMI 0 flow

Explanation: The corrected TIMI frame count quantifies flow using the number of cineangiographic frames for contrast to reach distal landmarks. Normal cTFC is <21 frames at 30 fps. Values >21-40 reflect slow flow, often from microvascular obstruction or suboptimal reperfusion.

About the ABIM Interventional Cardiology Exam

The ABIM Interventional Cardiology (IC) exam is the subspecialty board certification for cardiologists who have completed an ACGME-accredited 1-year Interventional Cardiology fellowship after their cardiovascular disease fellowship. The exam covers case selection (ISCHEMIA, COURAGE, SYNTAX), coronary anatomy, angiographic projections, invasive physiology (FFR ≤0.80, iFR ≤0.89, CFR, IMR, QFR), intracoronary imaging (IVUS/OCT with MSA ≥5.5 mm² target), acute coronary syndrome management (STEMI door-to-balloon 90 min, pharmacoinvasive for delayed transfer, cardiogenic shock), complex PCI (left main EXCEL/NOBLE, CTO hybrid algorithm, bifurcation MADS, atherectomy and IVL for calcium), antithrombotic therapy (DAPT duration, ARC-HBR short DAPT, BARC bleeding), vascular access (radial-first per RIVAL/MATRIX/TRACE-P), procedural complications, structural heart interventions (TAVR, MitraClip, Watchman, PFO closure), and peripheral vascular disease.

Questions

200 scored questions

Time Limit

~10-hour exam day (four ~2-hour modules)

Passing Score

Criterion-referenced scaled score (pass/fail)

Exam Fee

~$2,990 application + exam fee (American Board of Internal Medicine (ABIM))

ABIM Interventional Cardiology Exam Content Outline

20%

Case Selection & Pre-Procedural Evaluation

ISCHEMIA, COURAGE, SYNTAX/SYNTAX II for PCI vs CABG, left main EXCEL/NOBLE, heart team, CKD/AKI-CIN prophylaxis, DAPT planning (ARC-HBR, PRECISE-DAPT, DAPT score)

18%

Coronary Anatomy, Angiography & Physiology

LAD/LCX/RCA anatomy, dominance, Rentrop collateral grading, RAO/LAO views, TIMI flow 0-3, corrected TIMI frame count, FFR ≤0.80, iFR ≤0.89, CFR, IMR, QFR

15%

ACS — STEMI & NSTE-ACS

Primary PCI door-to-balloon 90 min, FMC-to-device 120 min transfer, pharmacoinvasive if delay >120, GRACE/TIMI risk, early invasive <24 hr high risk, SCAD, cardiogenic shock

12%

Complex PCI

Left main PCI vs CABG (EXCEL/NOBLE), CTO hybrid algorithm and J-CTO score, bifurcation MADS/DK-crush/culotte, rotational/orbital atherectomy burr rules, Shockwave IVL

10%

Intracoronary Imaging — IVUS & OCT

MLA thresholds, plaque morphology/TCFA, calcium arc on OCT, stent MSA ≥5.5 mm² or ≥90% distal reference, malapposition, edge dissection, ISR mechanisms

Antithrombotic Therapy & Bleeding

UFH vs bivalirudin, clopidogrel/prasugrel/ticagrelor, cangrelor for P2Y12-naive urgent, DAPT 6-12 mo elective vs ≥12 mo ACS, ARC-HBR 1-3 mo short DAPT, BARC criteria

Procedural Complications & Vascular Access

Ellis I/II/III perforation, no-reflow (verapamil, nicardipine, nitroprusside), air embolism, radial-first (RIVAL/MATRIX/TRACE-P), Barbeau test, femoral US, closure devices

Structural Heart Interventions

TAVR (Sapien/Evolut, gated CT sizing, conduction disease, paravalvular leak, cerebral protection), MitraClip COAPT vs MITRA-FR, Watchman FLX LAAO, PFO closure, ASD/VSD

Peripheral Vascular Intervention

PAD (ABI, SFA DCB/DES), renal artery (CORAL), carotid CAS vs CEA (CREST), AAA EVAR, catheter-directed thrombolysis and mechanical thrombectomy for PE (FLARE FlowTriever)

Post-Procedure Care & Secondary Prevention

Stent thrombosis (early/late/very late), high-intensity statin, ACEi/ARB, beta-blocker, GDMT for HFrEF, ICD ≥40 days post-MI if EF ≤35%, cardiac rehabilitation

How to Pass the ABIM Interventional Cardiology Exam

What You Need to Know

Passing score: Criterion-referenced scaled score (pass/fail)
Exam length: 200 questions
Time limit: ~10-hour exam day (four ~2-hour modules)
Exam fee: ~$2,990 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Interventional Cardiology Study Tips from Top Performers

1Memorize the invasive physiology thresholds cold — FFR ≤0.80 indicates ischemia, iFR ≤0.89 is the non-hyperemic cutoff, CFR <2.0 suggests combined epicardial plus microvascular disease, and IMR >25 defines significant coronary microvascular dysfunction. Know when FFR is unreliable (ostial lesions, serial stenoses, very diffuse disease) and when iFR is preferred (no adenosine needed, faster workflow)

2For STEMI timing, the numbers must be automatic: door-to-balloon ≤90 minutes at PCI-capable centers, first medical contact-to-device ≤120 minutes for transfer patients, and thrombolysis if anticipated delay >120 minutes followed by pharmacoinvasive strategy (routine early catheterization within 3-24 hours). For cardiogenic shock in STEMI, culprit-only PCI beat multivessel PCI in CULPRIT-SHOCK

3Know the IVUS/OCT stent optimization targets — minimum stent area (MSA) ≥5.5 mm² or ≥90% of the distal reference lumen area on IVUS, avoid underexpansion, malapposition, and significant edge dissection. For ISR, determine mechanism (neointimal hyperplasia vs neoatherosclerosis vs mechanical underexpansion) because treatment differs — mechanical causes often need IVL or atherectomy before re-stenting

4For DAPT duration, default to 6-12 months after elective PCI and ≥12 months after ACS, then individualize based on ARC-HBR criteria (≥1 major or 2 minor ARC-HBR features → consider 1-3 months short DAPT with aspirin monotherapy or P2Y12 monotherapy). Know the de-escalation trials (TOPIC switched to clopidogrel, TWILIGHT dropped aspirin at 3 months) and remember cangrelor for P2Y12-naive patients needing urgent PCI

5For complex PCI, know the go-to bailouts: coronary perforation — cover with fat/coil/covered stent by Ellis class; no-reflow — intracoronary verapamil, nicardipine, or nitroprusside plus adenosine; severely calcified lesions — rotational atherectomy (burr:artery ≤0.6, rotational speed 140,000-180,000 rpm, short runs), orbital atherectomy, or Shockwave IVL for deep calcium. Walk the CTO hybrid algorithm: antegrade wire escalation → antegrade dissection-re-entry (CrossBoss/Stingray) → retrograde approach

Frequently Asked Questions

Who can take the ABIM Interventional Cardiology exam?

Candidates must hold active ABIM Cardiovascular Disease subspecialty certification and have satisfactorily completed an ACGME-accredited 1-year Interventional Cardiology fellowship. The fellowship program director must attest to clinical and procedural competence. This follows a typical pathway of 3 years internal medicine residency + 3 years cardiovascular disease fellowship + 1 year IC fellowship (approximately 7 years of post-graduate training before eligibility).

How is the ABIM Interventional Cardiology exam structured?

The IC exam contains approximately 200 single-best-answer multiple-choice questions administered across four ~2-hour modules on a single ~10-hour test day at Pearson VUE centers. Many items are accompanied by angiographic or intravascular imaging (IVUS, OCT) still images or short cine clips. Content emphasizes clinical application of current guidelines (2021 ACC/AHA/SCAI Coronary Revascularization Guideline, 2023 ACC/AHA NSTE-ACS, TAVR guidelines) rather than rote recall.

What is a passing score for the ABIM IC exam?

ABIM uses a criterion-referenced scaled passing score established through standard-setting methodology. The score is reported as pass/fail, and the threshold is not publicly disclosed as a percentage. Historical first-time pass rates are approximately 90-93% for candidates who complete an ACGME-accredited IC fellowship.

How much does the ABIM Interventional Cardiology exam cost?

The application fee plus exam fee is approximately $2,990 for initial certification. Costs are subject to change — always confirm on the ABIM website. Total preparation cost including the SCAI interventional board review, Topol's Textbook of Interventional Cardiology, and a high-yield board review question bank typically ranges from $3,500 to $5,500.

What topics are emphasized on the ABIM IC exam?

The blueprint emphasizes Case Selection & Pre-Procedural Evaluation (~20%), Coronary Anatomy/Angiography/Physiology (~18%), ACS — STEMI and NSTE-ACS (~15%), Complex PCI including left main, CTO, bifurcation, and calcium (~12%), Intracoronary Imaging IVUS/OCT (~10%), Antithrombotic Therapy (~8%), Procedural Complications and Vascular Access (~7%), Structural Heart (~6%), and Peripheral/Post-Procedure (~4%). High-yield content includes FFR ≤0.80 and iFR ≤0.89 ischemia thresholds, stent MSA ≥5.5 mm², STEMI door-to-balloon timing, DAPT duration per ARC-HBR, and CTO hybrid algorithm.

How do I maintain ABIM IC certification?

ABIM diplomates maintain Interventional Cardiology certification through the Longitudinal Knowledge Assessment (LKA) — an open-book, quarterly question set delivered over a 5-year cycle — or through the traditional 10-year recertification exam. Diplomates must also meet MOC activity requirements, hold an active unrestricted medical license, and demonstrate ongoing procedural volume for center-level quality requirements (although ABIM does not set a procedural volume minimum for board certification).

How long should I study for the ABIM IC exam?

Most candidates study 250-400 hours over 6-12 months in parallel with their 1-year IC fellowship. Preparation typically combines the SCAI Interventional Cardiology Board Review course, Topol's Textbook of Interventional Cardiology, the 2021 ACC/AHA/SCAI Coronary Revascularization Guideline, SCAI expert consensus documents, and a dedicated board review question bank. Cath-lab procedural volume and conference-based case review are strong predictors of first-attempt success.

Is the ABIM IC exam the same as the SCAI examination?

They are different exams. ABIM Interventional Cardiology is the ABMS-recognized subspecialty board certification required for US credentialing and is the standard credential for practicing interventional cardiologists. SCAI offers quality and competency programs and a separate quality assessment, but does not replace ABIM subspecialty certification. Most US interventional cardiologists hold ABIM IC certification and are members of SCAI.