CSC Risk Assessment & Management 3 — Questions and Answers
Question 1: The Framingham Risk Score estimates 10-year risk of which primary cardiovascular endpoint?
- All-cause mortality
- Major adverse cardiac events (MACE)
- Hard coronary heart disease events (MI and coronary death) (Correct answer)
- Cardiovascular hospitalization
Correct answer: Hard coronary heart disease events (MI and coronary death)
The traditional Framingham Risk Score estimates the 10-year probability of hard coronary heart disease events, specifically myocardial infarction and coronary death.
Question 2: A 70-year-old patient with stable angina is found to have a SYNTAX score of 34. What does this imply for revascularization strategy?
- PCI is preferred over CABG
- CABG is associated with better outcomes than PCI (Correct answer)
- Medical therapy alone is recommended
- Either PCI or CABG is equally appropriate
Correct answer: CABG is associated with better outcomes than PCI
A SYNTAX score ≥33 (high complexity) indicates that CABG is associated with lower rates of MACE compared to PCI, per ESC/ACC guidelines.
Question 3: Which perioperative cardiac risk factor carries the GREATEST independent weight in the Revised Cardiac Risk Index (RCRI)?
- Hypertension on medication
- History of ischemic heart disease (Correct answer)
- Insulin-dependent diabetes
- Renal insufficiency (creatinine >2.0 mg/dL)
Correct answer: History of ischemic heart disease
History of ischemic heart disease is one of six equally weighted independent predictors in the RCRI; all six items carry equal weight in the index.
Question 4: Fractional flow reserve (FFR) values ≤0.80 indicate hemodynamically significant stenosis. What is the clinical implication for risk management?
- Medical therapy alone is sufficient regardless of symptoms
- Revascularization reduces the risk of future MI and death (Correct answer)
- Coronary artery bypass is mandated over PCI
- No further testing is needed; discharge the patient
Correct answer: Revascularization reduces the risk of future MI and death
FFR-guided revascularization for lesions ≤0.80 has been shown in trials like FAME to reduce major adverse cardiac events compared to medical therapy alone.
Question 5: Which biomarker has been validated as an independent predictor of cardiovascular mortality in patients with chronic heart failure beyond BNP/NT-proBNP?
- High-sensitivity CRP
- Troponin I
- Galectin-3 (Correct answer)
- D-dimer
Correct answer: Galectin-3
Galectin-3 is a validated biomarker of myocardial fibrosis and inflammation independently predictive of cardiovascular mortality in chronic heart failure.
Question 6: In the risk stratification of hypertrophic cardiomyopathy (HCM), which finding MOST strongly supports ICD implantation for primary prevention?
- Maximal wall thickness of 15 mm
- Resting LVOT gradient of 30 mmHg
- Two or more major SCD risk factors (e.g., family history, syncope, NSVT, massive LVH) (Correct answer)
- Mild mitral regurgitation on echocardiography
Correct answer: Two or more major SCD risk factors (e.g., family history, syncope, NSVT, massive LVH)
ACC/AHA HCM guidelines recommend ICD for primary prevention when patients have two or more major risk factors, or when a single factor confers very high individual risk.
Question 7: Statin therapy is most strongly indicated for primary prevention in a patient whose pooled cohort equation estimates a 10-year ASCVD risk of:
- 4%
- 6%
- 8%
- 12% (Correct answer)
Correct answer: 12%
The 2019 ACC/AHA guidelines recommend discussing statin therapy for primary prevention when the estimated 10-year ASCVD risk is ≥10%, making 12% a clear indication.
CSC Risk Assessment & Management 3
The Framingham Risk Score estimates 10-year risk of which primary cardiovascular endpoint?