Risk Stratification of Coronary Artery Disease

Question 1

the Framingham event-prediction score uses 4 characteristics to assess risk/susceptibility of getting CAD

Answer 1

1. diabetes
2. dyslipidemia
3. hypertension
4. smoking

Question 2

pros and cons of framingham criteria for CAD risk stratification

Answer 2

Pros
• Cheap • Readily Available

• Reasonable Positive Predictive Value ~ 70%

• Cons
• Poor Negative Predictive Value - ~30%
• Event Probability not Disease Detection
• Not Multi-Ethnic

Question 3

T/f the exercsise stress test hsas high sensitivity

Answer 3

false. it has low sensitivity. it is cheap and available, but it is not involved in disease identification or event prediction.

Question 4

pros and cons of nuclear myocardial perfusion imaging (with thallium)

Answer 4

Question 5

what better for disase detection? Stress echocariography or nuclear imaging during stress test?

Answer 5

nuclear imaging (thallium) during stress test.

stress echocardiography is good and a bit less expensive that nuclear imaging but it does have a reduced disease detection and there’s limited expertise in interpretation

Question 6

what is pharmacologic stress testing and pros and cons?

Answer 6

when you have an IV infusion of a stress agent and then watch the increase of myocardial oxygen demand and look at contractility.

Question 7

what is invasive CT angiography? What is non-invasive coronary angiography? Pros and cons

Answer 7

Invasive : freezing the radial artery, injecting due, and visualizing the coronary artery. It has increased risks of stroke and requires skilled practitioner.

pros; high PPV and high resolution, allows for revascularization planning. Cons includes increased risk of stroke, limited availability and expensive. It only images the vessel lumen

the non invasive option is still good but it provides only 1/3 the resolution of invasive coronary angiography. takes a lot longer too.

pros; cheaper, imagies the entire vessel wall, and high PPV.

cons; reduced safety profile, limited expertise, but still expensive.

Question 8

How does the coronary artery calcium score work

Answer 8

the more Ca2+ = the more plaque = the increased risk for CAD and worse prognosis. This is done in the CT scanner.

males>50 should have one done, and women over 60 should have one done.