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Acute coronary events continue to represent a threat to aviation safety and mission completion and comprise a significant cause of loss of medical certification in both military and civilian aircrew. In the age range of active aircrew, coronary events often present as a plaque rupture event with acute incapacitation as the initial manifestation. The identification of asymptomatic aircrew with a high risk for an acute coronary event remains a major challenge to aviation medical practitioners. For aircrew who have had a coronary event or are have significant atherosclerosis, the challenge is to guide the appropriate evaluations to allow a risk assessment for consideration for continuing flight duties.

Using a series of four case studies, this article will explore the evaluation, treatment, and proper aeromedical disposition of coronary artery disease (CAD). Cases will include CAD screening, asymptomatic non-obstructive CAD, asymptomatic obstructive/ischemic CAD, and symptomatic CAD with myocardial infarction.

This paper presents the current benchmark for assessing aircrew for occult coronary disease and for assessment and disposition of aircrew with known coronary disease with data derived from current aeromedical and clinical literature, as well as the expert consensus of the North Atlantic Treaty Organization Working Group on Occupational Cardiology (HFM WG 251, 316). Gray G, Holdsworth D, Guettler N, Broekhuizen L, Syburra T, D'Arcy J, Bron D, Manen O, Davenport E. Coronary artery disease detection and disposition in aircrew. Aerosp Med Hum Perform. 2026; 97(3):210-217.