Positive predictive value of cardiac fluoroscopy in asymptomatic U.S. Army aviators

The primary aim of this study was to determine the positive predictive value (PPV) of cardiac fluoroscopy in U.S. Army aviators. Cardiac fluoroscopy is one of the non-invasive tests used to screen for coronary artery disease (CAD) in the U.S. Army Cardiovascular Screening Program. The secondary objective is to determine the positive predictive value (PPV) of the combination of the aeromedical graded exercise test (GXT) and cardiac fluoroscopy. The results of these two screening tests are used to determine the need for coronary angiography. Records of 220 male aviators (mean age--42.3) who underwent coronary angiography from 1990-95 were obtained from the Aviation Epidemiology Data Register (AEDR) at Ft. Rucker, AL. These records contained results from the screening tests (GXT, cardiac fluoroscopy, and thallium scintigraphy) and coronary angiography. Significant CAD (SCAD) was present in 47 (21%), while 83 (38%) had minimal CAD (MCAD). The PPV of cardiac fluoroscopy was 81% for all CAD (34% for SCAD). GXT and thallium scintigraphy had a PPV of 62 and 67% for all CAD (23 and 45% for SCAD), respectively. The PPV's of the screening tests were not statistically different at the 95% confidence interval level. The combination of GXT and cardiac fluoroscopy had a PPV of 64% (21% for SCAD).