The transoceanic air evacuation of unstable angina patients

The United States Air Force (USAF) air evacuation system in the Western Pacific frequently transports unstable angina patients on fixed wing aircraft over long distances to reach definitive cardiologic and cardiothoracic capabilities. This study begins to answer the question: Does the transfer of unstable angina (i.e., crescendo angina or rest angina) patients over long distances adversely affect the overall outcome of such patients?

A case series study was conducted by obtaining a list of urgent and priority unstable angina patients from the Pacific theater from January 1992 through December 1996. Each of these patients' inpatient records were reviewed for cardiac catheterization (cath) result, ejection fraction (EF), previous cardiac history, angioplasty (PTCA) procedures, coronary artery bypass graft (CABG) surgery, and whether a patient had congestive heart failure (CHF), myocardial infarction (MI), death or other complications on this admission.

Of the 59 records reviewed, 61% (36/59) had coronary artery disease (CAD) of at least one vessel greater than 90% occlusion, 31% (18/59) had PTCA, 24% (14/59) had a CABG, 5% (3/59) had CHF, 3% (2/59) had an MI, 24% had some type of a complication, and 1.7% (1) died on this admission.

Patients with significant CAD seem to tolerate air transport well with relatively few complications considering the overall morbidity and mortality associated with the diagnosis of unstable angina.