Assessing extensive coronary artery disease using a myocardial jeopardy score based on coronary CT: long-term prognostic value

The British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) is an established, simplified scoring system for assessing coronary artery disease (CAD) extensiveness with excellent agreement between the invasive and the computed tomography (CT) angiography-based scores. Originally developed for use during invasive coronary angiography, it supports procedural planning and risk stratification by estimating the extent of myocardium at risk. The computed tomography (CT)-based version (CT-BCIS-JS) has shown excellent agreement with the invasive score. We aimed to investigate the value of the CT-BCIS-JS in predicting long-term outcomes. This retrospective single-center study included 337 patients referred for coronary CT angiography (CCTA). CT-BCIS-JS was calculated using a purpose-developed online calculator, and patients were divided into extensive and non-extensive CAD (BCIS ≥ 6 and BCIS < 6, respectively). The primary outcome was the composite of all-cause death and nonfatal myocardial infarction (MI) and the secondary outcome was major adverse cardiovascular events (MACEs), including all-cause mortality, MI, unstable angina requiring hospitalization, and coronary revascularization. Kaplan-Meier curves and multivariable-Cox regression analyses were utilized to compare outcomes between groups. Of the 337 patients, 249 (73.9%) patients had BCIS-JS < 6 and 88 (26.1%) patients had BCIS-JS ≥ 6. Overall, the primary outcome occurred in 47 (13.9%) patients over a median follow-up of 6.8 years (interquartile range 5.7-8.5 years). Thirthy-eight of them (43.2%) had BCIS-JS ≥ 6 compared to 9 (3.6%) in the BCIS-JS < 6 group (adjusted hazard ratio [aHR]: 11.15; 95% CI 4.97-24.99; p < 0.001). The secondary outcome occurred in 77 patients (87.5%) who had BCIS-JS ≥ 6 compared to 20 (8.0%) in the BCIS-JS < 6 group (aHR: 19.92; 95% CI: 11.40-34.81; p < 0.001). CT-BCIS-JS allows excellent risk stratification in patients with known or suspected CAD. Anatomically extensive CAD identified with the CT-BCIS-JS is a strong predictor of higher mortality, nonfatal MI, and MACE. Graphical representation of the definition, calculation and classification as well as the long-term prognostic significance of the coronary CT Angiography-Based British Cardiovascular Intervention Society Jeopardy Score (CT-BCIS-JS). The figure illustrates the method used to quantify myocardial jeopardy, the scoring algorithm, and its application in risk stratification for extensive coronary artery disease (CAD). Kaplan-Meier survival curves demonstrate the long-term clinical impact of the CT-BCIS-JS, with higher scores associated with poorer event-free survival.