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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\u2009\u2265\u20096 and BCIS\u2009&lt;\u20096, 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\u2009&lt;\u20096 and 88 (26.1%) patients had BCIS-JS\u2009\u2265\u20096. Overall, the primary outcome occurred in 47 (13.9%) patients over a median follow-up of 6.8 years (interquartile range 5.7\u20138.5 years). Thirthy-eight of them (43.2%) had BCIS-JS\u2009\u2265\u20096 compared to 9 (3.6%) in the BCIS-JS\u2009&lt;\u20096 group (adjusted hazard ratio [aHR]: 11.15; 95% CI 4.97\u201324.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The secondary outcome occurred in 77 patients (87.5%) who had BCIS-JS\u2009\u2265\u20096 compared to 20 (8.0%) in the BCIS-JS\u2009&lt;\u20096 group (aHR: 19.92; 95% CI: 11.40-34.81;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s10554-025-03520-9","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T03:28:33Z","timestamp":1760671713000},"page":"2173-2182","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing extensive coronary artery disease using a myocardial jeopardy score based on coronary CT: long-term prognostic value"],"prefix":"10.1007","volume":"41","author":[{"given":"Andreas A.","family":"Giannopoulos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexia","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios V.","family":"Moysidis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan A.","family":"Schaab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stjepan","family":"Jurisic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobia","family":"Albertini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Candreva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara E.","family":"St\u00e4hli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik C.","family":"Benz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronny R.","family":"Buechel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp A.","family":"Kaufmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aju P.","family":"Pazhenkottil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"3520_CR1","first-page":"e368","volume":"144","author":"M Gulati","year":"2021","unstructured":"Gulati M, Levy PD, Mukherjee D et al (2021) 2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American college of cardiology\/american heart association joint committee on clinical practice guidelines. 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All other authors report no personal conflicts of interests pertinent to this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional review board (the local Ethics Committee of the Canton of Zurich).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}