Why the study?
Optimal management strategies and aviation medicine considerations for aircrew with established coronary artery disease, previous myocardial infarction, or revascularisation require expert consensus guidance.
This expert consensus document provides specific occupational cardiology recommendations, allowing aircrew with established CAD or prior MI to return to restricted flight duties after 6 months if they demonstrate normal cardiac function and no residual ischemia.
Permits restricted flight return after 6 months in eligible aircrew; extends aviation cardiology guidelines with CAD-specific criteria.
This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with established coronary artery disease (CAD) without myocardial infarction (MI) or revascularisation (both pilots and non-pilot aviation professionals). It presents expert consensus opinion and associated recommendations and is part of a series of expert consensus documents covering all aspects of aviation cardiology.Aircrew may present with MI (both ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI)) as the initial presenting symptom of obstructive CAD requiring revascularisation. Management of these individuals should be conducted according to published guidelines, ideally with consultation between the cardiologist, surgeon and aviation medical examiner. Return to restricted flight duties is possible in the majority of aircrew; however, they must have normal cardiac function, acceptable residual disease burden and no residual ischaemia. They must also be treated with aggressive cardiac risk factor modification. Aircrew should be restricted to dual pilot operations in non-high-performance aircraft, with return to flying no sooner than 6 months after the event. At minimum, annual follow-up with routine non-invasive cardiac evaluation is recommended.
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Davenport et al. (2018) conducted a review in Coronary artery disease, myocardial infarction, and revascularization. Occupational medical management and risk stratification was evaluated. Aircrew with coronary artery disease, prior MI, or revascularization may safely return to restricted flight duties after 6 months if they have normal cardiac function and no residual ischemia.
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