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CC Jan 2017 Coronary Artery Calcium Scoring

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echoecho's version from 2017-03-12 23:59

Section

Question Answer
The presence of ______ in the coronary arteries is a marker of atherosclerotic lesions?Calcium
What is the coronary artery calcium score (CACS)?It is a quantitative measure of calcification detected on CT scanning
Calcium in the arteries is one factor associated with future risk of _____ events?Cardiovascular
The _____ score is used to delineate risk?Agatston
A score of > _____ Agatson units or > ___% for age/race/gender, indicates potentially high cardiovascular risk?> 300; 75%
Recent investigation has focused on the role of CACS (coronary artery calcium score) in refining ____ estimates?Risk
Previous American College of Cardiology / American Heart Association guidelines indicated that coronary artery calcium CT "is ______" (Class IIa recommendation) for asymptomatic patients with a 10-year intermediate Framingham risk of 10-20% and it "may be _______" (Class IIb recommendation) for asymptomatic patients with a 10-year low/intermediate risk of 6-10%?reasonable; reasonable
*** In 2013, the ACC/AHA released new guidelines endorsing sex and race-specificity predictive equations derived from 5 large prospective cohorts using conventional risk factors and estimating 10 or 30 years risks of major atherosclerotic cardiovascular disease events. The new guidelines state that CAC scoring "may be ______" if uncertainty remains after conventional risk assessment (Class IIb recommendation)?considered
*** The "intermediate risk category of the primary guideline was _______?eliminated
*** The 2013 ACC/AHA guideline on treatment of blood cholesterol states that use of additional factors including CACS (coronary artery calcium score), as well as ankle-brachial index (ABI), CRP, LDL > 160 and a strong family hx of premature cardiovascular disease "may be considered" to assist in the risk assessment of what 2 groups of individuals?1) < 40 or > 75 years of age "not otherwise identified in a statin benefit group" (I.e. without clinical ASCVD or diabetes and with an LDL < 190). 2) individuals 40-75 years of age NOT other wise identified in a statin benefit group and calculated 5 year risk of < 5%
CACS is NOT indicated in assessing either ___ risk or ____ risk patients (those already determined to require statin therapy), and there are no specific recommendations regarding CAC testing frequency?low; high
The 2016 European guidelines for cardiovascular disease prevention note that the CAC may be useful as an additional risk management tool in persons with a cardiac risk level between the ____% and ___% 10-year risk thresholds calculated using the Score risk estimator (a European tool on line at www.heartscore.org/Pages/welcome.aspx?5%; 10%
The European guidelines note that CAC is an _______ predictor of CAD and that "including CAC may improve CV risk prediction in addition to conventional risk factors"?independent
These European guidelines also note that a very low CAC score has a high _____ predictive value?negative
These European guidelines show that CAC score of 0 indicates a 10-year CV event risk of ___%?one
Why do these new European guidelines point out that other tools such as ankle-brachial index (ABI) may help delineate risk?because the detection of asymptomatic peripheral vascular disease with ABI can indicate concurrent CAD
*** Whether CACS measurement (and subsequent, yet-to-be- defined interventions) can improvement clinical outcomes is _______?Unknown (however, very low CACS scores might lead clinicians to defer statin therapy in some patients)
CACS measurement involves exposure to ionizing ______?radiation
The radiation dose depends on the ____ used; recent estimates of the dose are around ______ milliSieverts (mSv)?protocol; one
Some protocols may deliver higher radiation doses. Background radiation is _____ mSv/year?203
Additionally, patients are exposed to _____media and the attendant reactions?contrast
Coronary artery calcium burden is NOT the ________ characteristic most predictive of subsequent coronary events? List better predictors?1) plaque. 2) plaque burden. 3) thin fibrous caps 4) small luminal areas (< 4 mm)
Why can a patient (especially younger patients) have a CACS score of zero and still have CAD?because some plaques that rupture are soft, fatty atheromas without calcium
*** SUMMARY = What score may add information to traditional risk factors in selected patients?CACS (coronary artery calcium scoring)
*** SUMMARY = A very low score is a _____ predictor for 10 year coronary risk?negative
*** SUMMRY = CACS is NOT indicated as an assessment tool for either _____ or _____ risk patients?low; high
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