Author + information
- Anand Rohatgi, MD⁎ ( and )
- Jarett D. Berry, MD, MS
- ↵⁎Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room HA9.133, Dallas, Texas 75390-9047
Although Nambi et al. (1) report significant net reclassification (NRI) with the use of carotid ultrasound of 9.9% in the overall ARIC (Atherosclerosis Risk In Communities) cohort and 21.7% in the intermediate-risk group (5% to 20% 10-year risk) and conclude potential clinical utility in predicting cardiovascular events, the actual NRI tables for those with and without events need to be presented for full assessment of clinical utility. The NRI is determined by: 1) movement to higher risk categories among those with events; and 2) movement to lower risk categories among those without events (2). Although both components of the NRI are of interest, reclassification rates among those with events represent the more clinically relevant measure. However, Nambi et al. (1) do not provide separate reclassification tables for those with and without events to assess where the reclassification is occurring. Furthermore, 2 categories were used for intermediate risk (5% to 10% and 10% to 20%), and it is unclear what drove the net reclassification of 21% within this group: movement to >20% predicted risk in those with events, movement to <5% predicted risk in those without events, or movement within the 2 intermediate risk categories. Showing the actual NRI tables as described by Pencina et al. (2) would aid clinical interpretation. Finally, coronary revascularization and silent MI comprised 43% of the end points analyzed in the ARIC cohort; however, treatment changes would most likely occur for those with events who were reclassified upward to >20% predicted 10-year risk of hard end points alone. Complete assessment of clinical utility on the basis of improved reclassification can only be assessed by showing the full NRI tables for those with and without hard end points.
- American College of Cardiology Foundation