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Coronary artery calcium scoring vs. coronary CT angiography for the assessment of occupationally significant coronary artery disease

  • Author Footnotes
    1 Present Address: Buckinghamshire Healthcare NHS Trust.
    Jennifer Holland
    Footnotes
    1 Present Address: Buckinghamshire Healthcare NHS Trust.
    Affiliations
    Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
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  • Author Footnotes
    2 Present Address: Frimley Park Hospital.
    Leanne Eveson
    Footnotes
    2 Present Address: Frimley Park Hospital.
    Affiliations
    Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
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  • David Holdsworth
    Affiliations
    Oxford University Hospitals NHS Foundation Trust, OX3 9DU, UK
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  • Edward Nicol
    Correspondence
    Corresponding author. Faculty of School of Biomedical Engineering & Imaging Sciences, Kings College, London, WC2R 2LS, UK.
    Affiliations
    Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    Aviation Medicine Consultation Service, AMCS, RAF Henlow, SG16 6DN, UK

    Faculty of School of Biomedical Engineering & Imaging Sciences, Kings College, London, WC2R 2LS, UK
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  • Author Footnotes
    1 Present Address: Buckinghamshire Healthcare NHS Trust.
    2 Present Address: Frimley Park Hospital.
Published:February 14, 2022DOI:https://doi.org/10.1016/j.jcct.2022.02.005

      Abstract

      Background

      Existing pathways for investigating coronary artery disease (CAD) in individuals undertaking high-hazard employment are currently guided by coronary artery calcium scoring (CACS) or coronary CT angiography (CTA). The optimal pathway has not been established.

      Aim

      To compare the diagnostic outcome and occupational recommendations from two differing investigative pathways for the investigation of CAD in a cohort of high-hazard employees.

      Methods

      We collected CACS and coronary CTA data from three clinics across two Hospitals on 200 consecutive individuals employed in high-hazard occupations to confirm/exclude occupationally significant CAD. High-hazard occupations were grouped into civil/military pilots and aircraft controllers (n ​= ​106); non-pilot aircrew (NPA) (n ​= ​26); and ground-based (military) personnel (GBP) (n ​= ​52). Demographics, referral indications and recommended occupational outcomes between pathways were compared between groups.

      Results

      The CACS pathway led to more than double the number of individuals being returned to partial or full employment, compared with the coronary CTA pathway (OR 2.10, [95%CI 1.54–2.85], P ​< ​0.001). This effect was seen in all sub-groups.
      Of the 177 subjects that would have been returned to full employment using CACS, 21 (11.9%) would have been occupationally restricted on the basis of significant non-calcified plaque disease using coronary CTA (11.4% pilots/controllers; 19.2% non-pilot aircrew, and 7.7% ground-based personnel).

      Conclusion

      Using CACS to determine the presence of occupational CAD risks returning individuals to roles with occupationally significant CAD that may lead to an unacceptably high likelihood of an incapacitating/distracting acute coronary event. Coronary CTA appears to be a more reliable, non-invasive imaging modality for confirming or excluding occupationally significant CAD in high-hazard employees.

      Graphical abstract

      Keywords

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