CSC Risk Assessment & Management 2 — Questions and Answers
Question 1: Which validated scoring system best predicts in-hospital mortality after percutaneous coronary intervention (PCI)?
- SYNTAX score
- NCDR CathPCI Risk Score (Correct answer)
- EuroSCORE II
- GRACE score
Correct answer: NCDR CathPCI Risk Score
The NCDR CathPCI Risk Score was specifically developed and validated to predict in-hospital mortality following PCI procedures.
Question 2: A patient with chronic kidney disease (eGFR 28 mL/min/1.73m²) requires contrast angiography. Which intervention most effectively reduces contrast-induced nephropathy risk?
- N-acetylcysteine administration
- IV isotonic saline hydration before and after the procedure (Correct answer)
- Prophylactic hemodialysis post-procedure
- High-dose furosemide diuresis
Correct answer: IV isotonic saline hydration before and after the procedure
Adequate IV isotonic saline hydration before and after contrast administration is the most evidence-based intervention to reduce contrast-induced nephropathy.
Question 3: In the ACC/AHA heart failure staging system, a patient with structural heart disease but no symptoms of heart failure is classified as:
- Stage A
- Stage B (Correct answer)
- Stage C
- Stage D
Correct answer: Stage B
Stage B includes patients with structural heart disease (e.g., reduced EF, LVH, or prior MI) who have never had symptoms of heart failure.
Question 4: Which component of the HAS-BLED score accounts for the highest modifiable bleeding risk in atrial fibrillation patients on anticoagulation?
- Hypertension
- Labile INR
- Concomitant antiplatelet or NSAID use (Correct answer)
- Prior bleeding history
Correct answer: Concomitant antiplatelet or NSAID use
Concomitant use of antiplatelets or NSAIDs is a readily modifiable risk factor contributing to HAS-BLED bleeding risk score.
Question 5: What is the primary purpose of coronary artery calcium (CAC) scoring in cardiovascular risk stratification?
- To replace lipid panel testing
- To reclassify patients from intermediate to high or low risk (Correct answer)
- To diagnose obstructive coronary artery disease
- To measure myocardial perfusion reserve
Correct answer: To reclassify patients from intermediate to high or low risk
CAC scoring is used to reclassify intermediate-risk patients into higher or lower risk categories to guide statin and aspirin therapy decisions.
Question 6: In a patient with non-ST-elevation acute coronary syndrome (NSTE-ACS), the TIMI risk score assigns one point for each of the following EXCEPT:
- Age ≥65 years
- Prior coronary stenosis ≥50%
- ST deviation on ECG ≥0.5 mm
- Left ventricular ejection fraction <40% (Correct answer)
Correct answer: Left ventricular ejection fraction <40%
LVEF <40% is not a component of the TIMI risk score for NSTE-ACS; the seven variables include age, CAD risk factors, prior stenosis, ST changes, troponin, aspirin use, and anginal events.
Question 7: Which of the following patients is at HIGHEST risk for sudden cardiac death according to current risk stratification guidelines?
- LVEF 38%, NYHA Class I, no prior VT on ambulatory monitoring
- LVEF 25%, NYHA Class II, prior sustained VT documented (Correct answer)
- LVEF 42%, hypertrophic cardiomyopathy without obstruction
- LVEF 50%, long QT syndrome with corrected QT of 470 ms
Correct answer: LVEF 25%, NYHA Class II, prior sustained VT documented
A patient with severely reduced LVEF (≤35%), symptomatic heart failure, and prior sustained VT carries the highest absolute risk for sudden cardiac death.
CSC Risk Assessment & Management 2
Which validated scoring system best predicts in-hospital mortality after percutaneous coronary intervention (PCI)?