Coronary artery disease in aircrew fatalities: morphology, risk factors, and possible predictors

Coronary artery disease (CAD) is a common diagnosis at autopsies of military and civil aircrews. Identifying aviators with a high risk of an acute coronary syndrome is of aeromedical interest as it allows flight surgeons to employ prevention and intervention strategies to avoid death or a lifelong duties not including flying (DNIF) status of aircrew members. The aim of this study was to identify possible predictors of high-risk CAD.

In this aeropathological and aeromedical study the coronary artery systems of 21 German aircrew members killed in aircraft accidents was comprehensively examined. Then laboratory findings and bicycle ergometry results from their medical records were correlated to evaluate their predictive potential for CAD in our cohort.

Of those killed, 1/3 had no CAD whatsoever; the rest had mild, moderate, or severe CAD, depending on the classification system used. There were 48% who had findings considered disqualifying according to JAR FCL-3. Three cases (14%) showed thin cap fibroatheromas (TCFA). There were 15 ergometry tests recorded prior to the accident that could be reviewed. Minor findings were more frequent in the groups of more severe CAD, but not statistically significant. Laboratory findings did not correlate with CAD severity. Only serum cholesterol levels in the "disqualifying" group of the JAR-FCL classification were slightly higher compared to the remaining cases.

Our results suggest that ergometry findings may help to identify individuals with asymptomatic CAD. Further verification, e.g., by noninvasive coronary imaging, would then be the basis for strict cardiovascular risk management. For future aeropathological studies on the prevalence of CAD, we suggest that a classification system be established regarding higher degree luminal narrowing as well as plaque morphology, and especially the occurrence of TCFA.