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A comparison of coronary artery calcium scores vs. maximal stenosis vs. aggregate stenosis for the cardiovascular risk assessment of aircrew

Session EAPC Essentials 4 You - ePosters

Speaker Jennifer Holland

Event : EAPC Essentials 4 You 2020

  • Topic : imaging
  • Sub-topic : Cross-Modality and Multi-Modality Imaging Topics
  • Session type : ePosters

Authors : J Holland (London,GB), E Nicol (London,GB), L Eveson (London,GB), D Holdsworth (Oxford,GB), J D'arcy (Oxford,GB)

Authors:
J Holland1 , E Nicol1 , L Eveson1 , D Holdsworth2 , J D'arcy2 , 1Royal Brompton Hospital - London - United Kingdom of Great Britain & Northern Ireland , 2Oxford University Hospitals NHS Foundation Trust - Oxford - United Kingdom of Great Britain & Northern Ireland ,

Citation:

Background:

The role of Computed Tomography Coronary Angiography (CTCA) in assessing occupational risk in aircrew with suspected CAD has not been fully explored. We investigated how CTCA alters occupational disposition compared with coronary artery calcium scores (CACS), and functional imaging data, currently used by aviation regulatory bodies. 

Methods: 

Data from aircrew undergoing CTCA over 6 consecutive years were analysed. Demographics, CTCA (maximal stenosis and aggregate stenosis), CACS and occupational disposition pre- and post-CTCA were captured.

Results 

71 pilots (29% single seat, 26% rotary and 45% dual seat pilots) underwent CTCA. Initially, all aircrew were grounded due to an abnormal exercise test (48%), resting ECG (42%), cardiac symptoms (13%) or =2 cardiovascular risk factors (25%). 

After CTCA, 59% of pilots returned to unrestricted flying duties, 13% returned with occupational restrictions, with 28% remaining downgraded. In those with a CACS of <10, 7% had a stenosis of >50%. 12 (17%) of pilots with aeromedically significant CAD (as defined by EASA/CAA) would not have been detected on functional testing (i.e. those with a maximal stenosis <70%) and would have been returned to work.

Conclusions

CTCA can exclude CAD in most aircrew, allowing return to unrestricted flying. A substantial number of pilots with occupationally significant stenoses are not identified with either a CACS, or functional imaging.  The current use of these investigations by regulatory authorities (EASA/CAA) allows pilots at significant risk of coronary events to return to unrestricted flying. CTCA appears to be the most accurate non-invasive test to confirm and/or exclude suspected CAD in pilots and other high-hazard occupations.

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