Developed in collaboration with CASA Medical.
Coronary artery disease begins in young adult life. Most major adverse cardiac events (MACE) such as heart attacks or sudden cardiac death occur without prior symptoms. Few, if any, aircrew are involved in accidents and incidents suffer from antecedent symptomatic coronary disease. Most coronary events that occur in younger individuals occur because of the rupture of soft coronary plaques, or superficial erosion of remodelled plaque.
The screening of pilots and controllers with elevated cardiovascular risk is undertaken to detect asymptomatic coronary artery disease of safety relevance. CASA and CAA NZ use screening tools such as PREDICT/AUSCVD to determine if pilots or controllers have elevated cardiovascular risk. Pilots or controllers who have estimated elevated cardiovascular risk are required to see a cardiologist to help determine the extent and risk of any coronary artery disease.
A number of cardiac tests may be required to determine the risks of a major adverse cardiac event occurring that may lead to medical incapacitation. These guidelines allow pilots, controllers, and their treating cardiologists a choice of the further investigations. These are outlined in this guideline. Risk factor management is really important as the risk of future events is greatly reduced by lifestyle modification and the use of preventative medications.
CAA NZ Pilots or controllers with PREDICT 5-year risk estimation ≥10% have a condition that is of safety relevance or aeromedical significance unless coronary disease of safety relevance or aeromedical significance has been excluded.
For pilots or controllers with type 1 diabetes the Steno risk (Steno T1 Risk Engine(external link)) is a more specific risk calculator for type 1 diabetes related coronary artery disease risk. The same 5-year risk estimate of ≥10% applies as the threshold for further cardiology investigations.
For more information, see Medical Manual: Cardiovascular risk assessment.
