Validation of the British Cardiovascular Intervention Society Jeopardy Score from coronary CT angiography in TAVI candidates

Aims Severe aortic stenosis and coronary artery disease (CAD) frequently coexist in patients undergoing transcatheter aortic valve implantation (TAVI). The British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) is a well established score for determining CAD extent and jeopardized myocardium. The aim of the present study was to validate a CT-derived BCIS-JS (CT-BCIS-JS) against invasive angiography–derived BCIS-JS (iBCIS-JS) in TAVI candidates. Methods and results A total of 108 patients (median age 84 yrs, 43% female) undergoing CCTA prior to TAVI were included. CT-BCIS-JS and iBCIS-JS were both calculated and compared to each other with Spearman rank correlation and Bland-Altman analysis. Diagnostic performance of CT-BCIS-JS for detecting extensive CAD (iBCIS-JS ≥6) was assessed using sensitivity, specificity, positive and negative predictive values, and agreement was evaluated using Cohen’s kappa (κ). Correlation between CT-BCIS-JS and iBCIS-JS was good (Spearman’s rho = 0.61). Bland-Altman analysis demonstrated systematic overestimation of BCIS-JS with CT (by an average of 2.2 units) with rather wide limits of agreement (-4.6 to 9.1). A CT-BCIS-JS ≥6 had excellent sensitivity and negative predictive value (93% and 99% respectively) to detect extensive CAD on invasive angiography, but moderate to low specificity and positive predictive value (76% and 39%, respectively), and agreement for dichotomized BCIS-JS was moderate (κ = 0.44). Conclusion CT-BCIS-JS may serve as a reliable rule-out tool for extensive CAD, potentially reducing the need for invasive angiography in selected TAVI candidates, although systematic overestimation limits its rule-in capability.