Coronary artery disease in aircrew members: A French retrospective study

Abstract

Coronary artery disease (CAD) is a major preoccupation for flight surgeons because of the risk of in-flight incapacity it may lead to. That's why the prevention and the screening of CAD among aircrew members (AM) is systematic. The constant progress of cardiological tests, especially imaging, can help the flight surgeon to diagnose a CAD in AM before the onset of symptoms. The aims of this study are to describe the population of AM with a diagnosis of CAD, to analyze the tests performed that lead to the diagnosis and those performed for the AM rehabilitation. All the medical files of AM suffering from CAD were extracted from the 86,691 files of AM who were examined in our aeromedical center from 01/01/2010 to 12/31/2015. Our population was composed of 120 AM with a CAD (mean age: 53.2 ± 8.9 yo, 98.3% males, 79.2% civilians, 76.7% pilots). CAD were discovered on acute cardiovascular events (myocardial infraction/sudden death) for 55% of the population, and on moderated symptoms for 22.5% of the population. For the 22.5% others, the diagnosis was performed thanks to the systematical electrocardiogram or thanks to the prescription of paraclinic tests (exercise test, coronary tomography, cardiac MRI, myocardial scintigraphy) made as a result of an elevated cardio-vascular risk. The coronarography revealed a bitroncular stenosis for 29.1% of patients and a tritroncular stenosis for 24.8% of them. After a complete cardiological evaluation, 70% of AM were declared fit with waivers. Coronary tomography and stress tests are helping tools, which permit in our study to diagnose CAD before the onset of symptoms or acute events for a part of the population. Nowadays, the diagnosis of CAD is not synonymous of unfitness, even in pilots. A complete cardiological assessment remains mandatory in order to evaluate the sequels, the risk of complications and relapse. A multi-pilot limitation seems necessary for most of cases.