Differential diagnosis of coronary heart disease in aircrews and medical evaluation

Objective To further determine the clinical checking procedure of coronary heart disease (CHD) in aircrews, and investigate possibility of the flying qualification for the military aircrew with CHD who has been cured. Methods Treadmill exercise test, coronary computed tomography angiography (CTA), single photon emission computed tomography (SPECT) myocardial perfusion imaging and coronary angiography were performed in 134 aircrews who were suspected with CHD, and their availability of the CHD diagnosis was evaluated. By following-up 8 flying qualified aircrews whose CHD had been cured, the flying adaptability was evaluated. Results The sensitivity of treadmill exercise test, coronary CTA, SPECT myocardial angiography and coronary angiography, was 66.7%, 88.9%, 50.0% and 94.4%, the specificity was 67.6%, 89.3%, 94.1% and 100.0%, the positive predictive value was 14.3%, 57.1%, 66.7% and 100.0%, and the negative predictive value was 96.2%, 98.0%, 88.9% and 95.2%, respectively. Eight flying qualified aircrew with CHD had returned to flying for 24-72 months and flied 40-150 h per year. Their state of illness was in stabilization and had a good flying adaptability. Conclusions Treadmill exercise test and coronary CTA can be used as effective methods to screen and exclude CHD in aircrew. Coronary angiography can be the method of finally diagnosing CHD. CHD cured aircrews who fly such airplane as transports and helicopters can be issued conditional qualification for the safety. Key words: Coronary disease; Diagnosis; Eligibility determination; Aircrews