M6 Comparing CTCA and CACS in assessing risk in high hazard occupations

Introduction The role of Computed Tomography Coronary Angiography (CTCA) in assessing occupational risk in individuals in high hazard occupations with suspected CAD has not been fully explored. We explored how CTCA alters occupational disposition compared with coronary artery calcium scores (CACS), currently used by employers and regulatory bodies. Methods 6-year consecutive data from high hazard employees undergoing CTCA were analysed. Demographics, CTCA (maximal stenosis and aggregate stenosis), CACS and occupational disposition pre- and post-CTCA were captured. Results CTCA data from 139 individuals were collected; comprising 82 pilots and air traffic controllers, and 57 non-pilot aircrew and ground-based employees. Initially, all individuals were medically restricted due to an abnormal exercise test (35%) or resting ECG (36%), cardiac symptoms (27%) or ≥2 risk factors (25%). After CTCA, 61% of pilots and controllers were returned to unrestricted flying, and 60% of non-pilot aircrew/ground-based employees were fully employable. Of the pilots and controllers with a CACS of Conclusion CTCA effectively excludes CAD in most high hazard employees, allowing return to unrestricted roles. However, a substantial proportion with occupationally significant stenoses are not identified with CACS. Current use of these investigations by regulatory authorities/employers allows those at significant risk of coronary events to return to unrestricted high hazard employment. CTCA appears the most accurate non-invasive test to confirm or exclude suspected occupationally relevant CAD in high-hazard occupations.