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

Jennifer Holland; Leanne Eveson; David Holdsworth; Edward Nicol

doi:10.1016/j.jcct.2022.02.005

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

J Cardiovasc Comput Tomogr. 2022 Sep-Oct;16(5):454-459. doi: 10.1016/j.jcct.2022.02.005. Epub 2022 Feb 15.

Authors

Jennifer Holland¹, Leanne Eveson¹, David Holdsworth², Edward Nicol³

Affiliations

¹ Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
² Oxford University Hospitals NHS Foundation Trust, OX3 9DU, UK.
³ 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. Electronic address: e.nicol@nhs.net.

PMID: 35219609
DOI: 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.

Keywords: CACS; Coronary CTA; Coronary artery disease; High-hazard occupations.

MeSH terms

Calcium
Computed Tomography Angiography
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Humans
Predictive Value of Tests
Risk Assessment

Substances

Calcium