Parsons Iain, Pavitt Chris, Chamley Rebecca, d'Arcy Jo, Nicol Ed
Aerosp Med Hum Perform. 2017 Feb 1;88(2):76-81. doi: 10.3357/AMHP.4636.2017.
To ensure flight safety military aircrew undergo regular clinical and occupational assessment. Coronary artery calcium scoring (CACS) has been established as an imaging modality to noninvasively assess coronary artery disease (CAD). CT coronary angiography (CTCA) potentially offers a more accurate assessment of CAD, but has not been formally assessed in military aircrew. This retrospective cohort study is designed to compare the theoretical differences in downstream investigations and occupational outcomes in aircrew with suspected CAD comparing CTCA with existing CACS pathways.
A 2-yr retrospective cohort study of consecutive UK military patients who underwent a CTCA and CACS was undertaken. Patient demographics, CTCA and CACS results, and initial and final occupational restrictions were analyzed comparing current UK, Canadian, and U.S. pathways.
There were 44 patients who underwent CACS and CTCA. The commonest indication for a CTCA was a positive exercise ECG. Increasing CACS, stenosis severity, and stenosis burden were associated with significantly greater likelihood of occupational restriction (P = < 0.01). Following CTCA, 26/44 (59%) patients were found to have evidence of CAD, with 13/44 (30%) having at least a single vessel stenosis ≥50%. All of these patients had subsequent occupational restrictions. Two patients with a calcium score ≤10 had at least 1 single vessel stenosis ≥50%.
A CTCA pathway is potentially a better discriminator of CAD burden in aircrew when compared with CACS and may reduce downstream testing, allowing a more efficacious approach to CAD assessment in military aircrew.Parsons I, Pavitt C, Chamley R, d'Arcy J, Nicol E. CT coronary angiography vs. coronary artery calcium scoring for the occupational assessment of military aircrew. Aerosp Med Hum Perform. 2017; 88(2):76-81.
为确保飞行安全，军事飞行人员需定期接受临床和职业评估。冠状动脉钙化评分（CACS）已成为一种用于无创评估冠状动脉疾病（CAD）的成像方式。CT冠状动脉造影（CTCA）可能对CAD提供更准确的评估，但尚未在军事飞行人员中进行正式评估。这项回顾性队列研究旨在比较疑似CAD的飞行人员中，将CTCA与现有的CACS途径相比较时，下游检查和职业结局的理论差异。
对连续接受CTCA和CACS检查的英国军事患者进行了一项为期2年的回顾性队列研究。分析了患者的人口统计学数据、CTCA和CACS结果以及最初和最终的职业限制，并与当前英国、加拿大和美国的途径进行比较。
有44例患者接受了CACS和CTCA检查。CTCA最常见的指征是运动心电图阳性。CACS增加、狭窄严重程度和狭窄负荷与职业受限的可能性显著增加相关（P = <0.01）。CTCA检查后，26/44（59%）的患者被发现有CAD证据，其中13/44（30%）至少有一处单支血管狭窄≥50%。所有这些患者随后都有职业限制。两名钙评分≤10的患者至少有一处单支血管狭窄≥50%。
与CACS相比，CTCA途径可能是飞行人员CAD负荷的更好鉴别方法，并且可能减少下游检查，从而在军事飞行人员中采用更有效的CAD评估方法。
帕森斯I、帕维特C、查姆利R、达西J、尼科尔E。CT冠状动脉造影与冠状动脉钙化评分在军事飞行人员职业评估中的比较。航空航天医学与人类表现。2017；88（2）：76 - 81。
