Letter by Romanens Regarding Article, “Carotid Plaque Area and Intima-Media Thickness in Prediction of First-Ever Ischemic Stroke: A 10-Year Follow-Up of 6584 Men and Women: The Tromsø Study”
To the Editor:
We read with great interest that the carotid total plaque area (TPA) appears as a better independent predictor for ischemic stroke than carotid intima-media thickness. When analyzed with Kaplan-Meyer survival analysis corrected for a number of major cardiovascular risk factors, TPA was superior to intima-media thickness.1 Although TPA was an independent predictor for ischemic stroke, it failed when receiver-operator characteristic curve analysis was applied to the cohort. Unfortunately, the absolute amount of TPA plaque (in mm2) by quartiles was not reported. To better understand the clinical value of TPA as a sequential test in primary care for the prevention of incident ischemic stroke at the individual level, we suggest calculating the net reclassification improvement of TPA and intima-media thickness and publishing the absolute values of TPA with respect to the quartiles mentioned.2 Further, to be able to calculate posterior probabilities, eg, using the Bayes theorem, it would be helpful for the clinician if authors would also communicate the sensitivity and specificity of TPA and intima-media thickness to detect incident ischemic stroke for each quartile separately by sex.
Michel Romanens, MD
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- © 2011 American Heart Association, Inc.