Management of established coronary artery disease in aircrew without myocardial infarction or revascularisation

Area of Science:

• Aviation Cardiology
• Aerospace Medicine
• Cardiovascular Disease Management

Background:

• Established coronary artery disease (CAD) presents unique challenges for aircrew fitness.
• Managing pilots and non-pilot aviation professionals with CAD requires specific medical considerations.
• Previous guidelines may not fully address non-obstructive or hemodynamically insignificant CAD in aircrew.

Purpose of the Study:

• To provide expert consensus and recommendations for managing aircrew with established coronary artery disease without myocardial infarction or revascularization.
• To define criteria for return-to-flying status for aircrew with varying degrees of coronary artery disease.
• To outline optimal cardiac risk factor modification and follow-up protocols for affected aircrew.

Main Methods:

• Expert consensus review of current literature and clinical practice in aviation cardiology.
• Development of specific recommendations based on the hemodynamic significance and total burden of coronary artery disease.
• Inclusion of criteria for plaque morphology and aggregate stenosis assessment.

Main Results:

• Aircrew with non-obstructive CAD or obstructive CAD not hemodynamically significant may return to flying with restrictions.
• Aircrew with hemodynamically significant CAD (e.g., decreased fractional flow reserve) or >120% aggregated stenosis are recommended for grounding.
• The majority of aircrew with CAD can return to flight duties with aggressive risk factor modification and annual cardiac evaluations.

Conclusions:

• A nuanced approach to managing aircrew with coronary artery disease is essential for flight safety.
• Hemodynamic significance and total disease burden are critical factors in determining flying status.
• Proactive cardiac risk factor management and regular monitoring are key to enabling safe return to flight duties for most affected aircrew.