ASMA 2012 MEETING ABSTRACTS
Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012
249
total) were for changes in Inferior leads. Only 4 out of the 26 cases were detected to have perfusion defects and later underwent coronary angiography followed by revascularization. Three MPIs were done for patients who underwent primary PTCA to check for the success of revascularization. Nine cases were follow up cases of CAD. There were 7 cases referred for atypical chest pain out of which one case turned out to have RPD in inferior segments There were 5 cases referred for having positive TMT to exclude false positivity. Only one out them (20%) was detected to be positive with reversible perfusion defect in the apical segments. DISCUSSION: MPI has the advantage of detection of CAD at a very early stage when only fl ow heterogeneity is present. MPI has a much better diagnostic accuracy than stress ECG alone. Although coronary angiography provides clinically valuable information, its invasive nature and costs precludes its routine use in the evaluation of patients after interven-tion. MPI with its ability to provide information about the physiologi-cal signifi cance of stenosis, extent of ischemia and scar, global LV function, viability and prognosis is ideally suited to assess patients after intervention.
Learning Objectives:
1 Conclusion- The aviators are a special group of people in whom we need to use MPI more liberally due to its high negative predictive value, non-invasive nature and lower costs.
5:00 pm
[138] AEROMEDICAL DECISION MAKING IN CORONARY
ARTERY DISEASE REVISITED
P.D. NAVATHE, D. FITZGERALD, M. DRANE AND
M. DODSON
Offi ce of Aviation Medicine, Civil Aviation Safety Authority,
Canberra City, ACT, Australia
INTRODUCTION: Coronary Artery Disease (CAD) is a common condition in the pilot population, and presents as a diffi cult aeromedi-cal problem. METHODS: The spectrum that this condition can present is impressive, ranging from asymptomatic pilots who are detected to have CAD, asymptomatic CAD which has been detected, or pilots with symptomatic CAD who have had a multiplicity of surgical cardiologi-cal or medicardiologi-cal interventions. The number of aviators affected by this condition is more or less stable, but with new treatment and new diagnostic methods being evolved, there is a plethora of different situations that can apply in otherwise similar cases. RESULTS: Appropriate and consistent aeromedical decision making is becoming an increasingly diffi cult process. DISCUSSION: CASA has proposed a paradigm for the assessment and follow-up of these aviators, which is evidence based, and balances the national safety needs with the issues of individual liberty. The paradigm is presented as a starting point for possible harmonisation in such decision making.
Learning Objectives:
1 Understanding how to detect CAD
2 The best methods of dteceting jeopardised myocardium 3 Follow up of pilots with CAD
5:15 pm
[139] DOES CARDIOVASCULAR RISK ASSESSMENT OF
PILOTS DETECT CARDIOVASCULAR DISEASE AND PREVENT
SUDDEN CLINICAL PRESENTATIONS?
A. WIRAWAN
1,4, S. ALDINGTON
2,1, R.F. GRIFFITHS
1,
C.J. ELLIS
3AND P. LARSEN
11
Occupational and Aviation Medicine Unit, Department of
Medicine, University of Otago Wellington, Wellington, New
Zealand;
2Air New Zealand Aviation Medicine Unit, Auckland,
New Zealand;
3Green Lane CVS Service, Cardiology
Department, Auckland City Hospital, Auckland, New Zealand;
4
Occupational Health Department, School of Public Health,
Faculty of Medicine, Udayana University, Denpasar, Indonesia
INTRODUCTION: Due to the potential for cardiovascular disease (CVD) to cause pilot incapacitation, screening of pilot cardiovascular risk to detect and treat disease and prevent sudden onset events is current practice. In New Zealand, the Civil Aviation Authority has routinely applied an adjusted Framingham-based cardiovascular risk prediction score to do this. This study examined cardiovascular disease (CVD) events occurring in a commercial pilot population, and examined the sensitivity and specifi city of the current cardiovascular risk score in predicting these events. METHODS: A matched case-control design was applied to assess the association of 5-year cardiovascular risk score and cardiovascular events in an Oceania based airline pilots. Cases were pilots with cardiovascular events as recorded on their medical records. Each case was age and gender matched with 4 controls that were randomly selected from the pilot population. Five-year retrospective evaluations were conducted to collect data before the events. RESULTS: Fifteen cases of cardiovascu-lar events were identifi ed over a 16-year study period, 9 (60%) of which were sudden clinical presentations, and only 6 (40%) of which were detected using cardiovascular screening. Eight cases (53%) and 16 controls (27%) had a 5-year risk of t10-15%. Almost half of the events (7/15) occurred in pilots whose highest 5-year risk was in the 5-10% range. Cases were nearly 4 times more likely to have highest 5-year risk score of t10-15% than controls (OR = 3.91, 95% CI 1.04-16.35, p = 0.04). The accuracy of the highest risk score were moderate (AUC = 0.723, 95% CI 0.583-0.863). The cut-off point of 10% is valid with specifi city of 0.73 but low sensitivity (0.53). DISCUSSION: Despite a valid and appropriate cut-off point, the tool had low sensitivity and was unable to predict almost half of the cardiovascular events. The majority of CVD events remain sudden onset clinical presentations.
Learning Objectives:
1 The association between the cardiovascular risk score and cardio-vascular events in airline pilots is described
Monday, May 14
4:00 PM
Ballroom C
SLIDE: DECOMPRESSION SICKNESS AND
HYPOXIA
4:00 pm
[140] DCS IN THE SWEDISH AIR FORCE. A SURVEY AND
EXPERIMENTAL STUDY
L.G. HÖK
1, R. WETTERHOLM
1, B. WALL
1AND
D.R. LEMMING
1,
21
