RT Journal Article SR Electronic T1 The challenge of asymptomatic coronary artery disease in aircrew; detecting plaque before the accident JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP s17 OP s24 DO 10.1136/heartjnl-2018-313053 VO 105 IS Suppl 1 A1 Gary Gray A1 Eddie D Davenport A1 Dennis Bron A1 Rienk Rienks A1 Joanna d’Arcy A1 Norbert Guettler A1 Olivier Manen A1 Thomas Syburra A1 Edward D Nicol YR 2019 UL http://heart.bmj.com/content/105/Suppl_1/s17.abstract AB Coronary events remain a major cause of sudden incapacitation, including death, in both the general population and among aviation personnel, and are an ongoing threat to flight safety and operations. The presentation is often unheralded, especially in younger adults, and is often due to rupture of a previously non-obstructive coronary atheromatous plaque. The challenge for aeromedical practitioners is to identify individuals at increased risk for such events. This paper presents the NATO Cardiology Working Group (HFM 251) consensus approach for screening and investigation of aircrew for asymptomatic coronary disease.A three-phased approach to coronary artery disease (CAD) risk assessment is recommended, beginning with initial risk-stratification using a population-appropriate risk calculator and resting ECG. For aircrew identified as being at increased risk, enhanced screening is recommended by means of Coronary Artery Calcium Score alone or combined with a CT coronary angiography investigation. Additional screening may include exercise testing, and vascular ultrasound imaging. Aircrew identified as being at high risk based on enhanced screening require secondary investigations, which may include functional ischaemia, and potentially invasive coronary angiography. Functional stress testing as a stand-alone investigation for significant CAD is not recommended in aircrew. Aircrew identified with coronary disease require further clinical and aeromedical evaluation before being reconsidered for flying status.