P4451Screening for Coronary Artery Disease USing Primary Evaluation with Cardiac CT (SUSPECT) in Aviation Medicine in the Royal Netherlands Air Force

Abstract

Abstract Background Military aircrew are subjected to both stress and excessive G-forces, which may be associated with an increased risk of coronary artery disease (CAD) and sudden cardiac death. Annual cardiac screening has therefore been implicated using exercise testing, which suffers from both false-positive and false-negative results. In this study, we have evaluated the prevalence of CAD in military aircrew using cardiac computed tomography (CT), and assessed whether cardiac CT would be a useful screening tool within this population. Methods Prospective, single-center, cohort study in 250 asymptomatic aircrew >40 years old in the Royal Netherlands Air Force. Included subjects underwent cardiac CT, in addition to the routine annual check-up that included an electrocardiogram, exercise test and laboratory analysis. Primary endpoint was obstructive CAD, defined as a coronary stenosis ≥50%. Secondary endpoints were non-obstructive CAD (<50% stenosis) and coronary artery calcium score (CACS) >100. Results Of the first 108 inclusions, mean age was 49 years (range 40–57), 99% were male and mean body mass index was 25.8 (SD 2.6). The prevalence of hypertension was 8%, hypercholesterolemia 9% and familial heart disease was noted in 22%. 16% were active smokers and none had diabetes. Obstructive CAD was observed in 2% of patients, non-obstructive CAD in 40% and CACS >100 in 11%. All subjects with obstructive CAD on cardiac CT underwent coronary artery angiography, which confirmed a stenosis >70% that required revascularization. Conclusion In asymptomatic military aviation aircrew >40 years old currently active in the Royal Netherlands Air Force, the prevalence of obstructive and non-obstructive CAD was 2% and 40%, respectively Acknowledgement/Funding Royal Netherlands Air Force