Percutaneous transluminal coronary angioplasty (PTCA): long-term outcome and aeromedical implications.

BACKGROUND

Currently U.S. Air Force aviators are permanently disqualified from all military flying duties after PTCA.

HYPOTHESIS

We wondered if a low risk group of post-PTCA patients was identifiable from the literature, such that trained aviators who met the criteria for such a group could be safely returned to military flying duties.

METHOD

We reviewed the PTCA literature from 1978-93 for long-term outcome (cardiac events) and patient characteristics that might affect outcome. Cardiac events were cardiac death, myocardial infarction (MI), and need for bypass surgery or repeat PTCA due to restenosis or progression of coronary artery disease (CAD).

RESULTS

All patients were at risk for restenosis, the rate being highest in the first year post-PTCA (17-34%), and 10-40% of asymptomatic patients had restenosis. Noninvasive tests during the first 12 mo missed 25-54% of significant restenoses found by angiography. Beginning 1 yr after successful PTCA, cardiac event rates (excluding angina pectoris) were 2.4-4.1% yr, as opposed to < 1%/ yr (including angina) in our asymptomatic, untreated, mild-moderate CAD aviator population. The late annual event rate did not decline in over 5 yr of follow-up. Significant CAD progression in other sites or vessels occurred in 39-45% of asymptomatic patients by 5-8 yr; 13-43% of successful PTCA survivors were experiencing angina 3-6 yr post-PTCA. None of the following patient characteristics lowered the event rates: absence of symptoms before or after PTCA, PTCA in single-vessel disease, age < 40 at time of PTCA, post-PTCA lesion < or = 30%, and lack of prior MI.

CONCLUSION

No low risk subgroup of patients or safe waiting period post-PTCA could be identified by literature review. We cannot recommend return to any type of military flying duties at any time after PTCA because of the significant and steady rate of serious cardiac events.