Table 1

Coronary artery disease classifications for aeromedical disposition

	Stenosis (%)	FFR	Annual MACE (%)	Pilot aircrew disposition	Non-pilot aircrew disposition*
Haemodynamically significant	≥70	<0.8	>3.0	Grounded†	Grounded†
Single vessel obstructive (non-haemodynamically significant)	50–69	>0.8	1.0–3.0	With restrictions‡§	Unrestricted possible‡§*
Single vessel non-obstructive	30–49	>0.8	1.0–3.0	With restrictions‡	Unrestricted possible*
Luminal irregularities	Up to 30	>0.8	0.5–1	Unrestricted possible‡	Usually unrestricted ‡*
Aggregate stenosis: severe	≥120	N/A	>3.0	Grounded†	With restrictions†*
Aggregate stenosis: moderate	50–119	N/A	1.0–3.0	With restrictions‡	Unrestricted possible‡*
Aggregate stenosis: mild	<50	N/A	0.5–1.5	Unrestricted possible‡	Unrestricted possible‡*
Left main stenosis: significant	30–49	N/A	1.0–3.0	With restrictions‡§	Usually with restrictions‡§*
Left main stenosis	≥50	N/A	>3.0	Grounded†	Grounded†

*Will depend on aircrew role and individual agency acceptable risk threshold.
†Without revascularisation; return to flight (in a limited capacity) may be possible after revascularisation.
‡With aggressive risk factor modification and close follow-up, restricted return to flight duties may be possible depending on the risk threshold accepted by the individual aircrew’s respective regulatory authority.
§Wide discrepancy in disposition in difference agencies. Federal Aviation Administration would allow for flight duties with restrictions, European Aviation Safety Agency would permanently ground aircrew.
FFR, fractional flow reserve; MACE, major adverse cardiovascular event.