Why the study?
Optimal management strategies and aeromedical disposition for aircrew with established coronary artery disease without myocardial infarction or revascularisation require expert consensus due to unique occupational risks and lack of specific guidelines.
How should aircrew with established coronary artery disease without myocardial infarction or revascularisation be managed regarding return to flight duties?
How should aircrew with established coronary artery disease without myocardial infarction or revascularisation be managed regarding return to flight duties?
Expert consensus recommends that aircrew with non-haemodynamically significant CAD can safely return to flight duties with aggressive risk factor modification and annual non-invasive evaluation, while those with significant CAD or excessive burden should be grounded.
Informs return-to-flight decisions for aircrew with CAD; extends expert consensus on risk-stratified occupational fitness criteria.
This paper is part of a series of expert consensus documents covering all aspects of aviation cardiology. In this manuscript, we focus on the broad aviation medicine considerations that are required to optimally manage aircrew with established coronary artery disease in those without myocardial infarction or revascularisation (both pilots and non-pilot aviation professionals). We present expert consensus opinion and associated recommendations. It is recommended that in aircrew with non-obstructive coronary artery disease or obstructive coronary artery disease not deemed haemodynamically significant, nor meeting the criteria for excessive burden (based on plaque morphology and aggregate stenosis), a return to flying duties may be possible, although with restrictions. It is recommended that aircrew with haemodynamically significant coronary artery disease (defined by a decrease in fractional flow reserve) or a total burden of disease that exceeds an aggregated stenosis of 120% are grounded. With aggressive cardiac risk factor modification and, at a minimum, annual follow-up with routine non-invasive cardiac evaluation, the majority of aircrew with coronary artery disease can safely return to flight duties.
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Davenport et al. (2018) conducted a review in Coronary artery disease. Aeromedical disposition and risk factor modification guidelines was evaluated. Aircrew with non-haemodynamically significant CAD may return to flight duties with restrictions and risk factor modification, while significant CAD requires grounding or revascularization.
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