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

Background: Existing pathways for investigating coronary artery disease (CAD) in individuals undertaking highhazard 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. Highhazard 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.