Validation of the BCIS-1 myocardial jeopardy score using cardiac magnetic resonance perfusion imaging

The recently described angiographic BCIS-1 Myocardial Jeopardy Score (BCIS-JS) provides a semi-quantitative estimate of the extent of coronary artery disease (CAD). It is simple to use and applicable to all patients including those with bypass grafts. Our objective was to validate the BCIS-JS by evaluating its correlation with myocardial ischaemic burden and its accuracy at predicting a prognostic ischaemic threshold. Seventy-five patients with angina and known or suspected CAD referred for coronary angiography prospectively underwent high-resolution CMR perfusion imaging. There was good correlation between the BCIS-JS and myocardial ischaemic burden: r = 0·75, P<0·0001. Area under the ROC curve for BCIS-JS to detect ≥12% myocardial ischaemic burden was 0·87 (95% CI 0·78–0·96). BCIS-JS ≥6 predicted ≥12% myocardial ischaemic burden with a sensitivity of 68% and a specificity of 91%. The BCIS-JS correlates well with myocardial ischaemic burden. A BCIS-JS ≥6 predicts the prognostically important ischaemic threshold of 12% with high specificity. These findings demonstrate that the BCIS-JS has functional relevance and support its utility for classification of CAD burden in clinical trials and in clinical practice.