Coronary Artery Disease Screening Using CT Coronary Angiography

Area of Science:

• Cardiology
• Aerospace Medicine
• Radiology

Background:

• CT coronary angiography (CTCA) is increasingly used for cardiovascular screening in aircrew.
• This has led to more frequent detection of asymptomatic coronary artery disease (CAD).
• A systematic review was conducted to inform aeromedical disposition pathways for aviators with asymptomatic CAD.

Purpose of the Study:

• To systematically review studies on CTCA interpretation for occupational fitness assessment in high-risk vocations.
• To develop a pathway for the aeromedical disposition of military aviators with asymptomatic CAD.

Main Methods:

• A systematic review of Medline was performed using terms related to CT coronary angiography, screening, and prognosis.
• Inclusion criteria focused on asymptomatic adults (>18 years) without known CAD who underwent CTCA.
• Outcomes assessed included major adverse cardiovascular events (MACE) and other cardiac events.

Main Results:

• Ten studies were included in the review.
• Obstructive CAD on CTCA was associated with significantly higher hazard ratios (HR) for cardiac events (1.42–105.48) compared to no or nonobstructive CAD.
• Nonobstructive CAD showed a lower HR (1.19) for cardiac events compared to no CAD, with annual event rates of 0–0.5% for those with no CAD.

Conclusions:

• CTCA screening should be reserved for aircrew with higher cardiac risk profiles.
• Aircrew with no or minimal CAD (≤25% stenosis) in non-left main coronary arteries on CTCA can be cleared for flying duties.
• Other CTCA findings warrant further evaluation with invasive angiography.