What is acceptable revascularization of the myocardium in the context of certification to fly?

Acceptable revascularization of the myocardium in the context of certificat ion to fly can be achieved by surgery, preferably using arterial grafts, or angioplasty, with or without coronary artery stenting. The licensing requi rement for a coronary angiogram to be carried out 6 months following the in dex intervention, identifies appropriate anatomy which should demonstrate n o stenosis greater than 30% in any major epicardial artery which has not be en grafted, or in any vessel which has undergone coronary angioplasty and/o r stenting. An exception is a vessel subtending a completed infarction. Lik ewise, an arterial or venous graft should have no more severe stenosis. Exe rcise electrocardiography or, preferably myocardial scintigraphy, should sh ow no evidence of myocardial ischaemia. Exercise induced perfusion abnormal ities imply incomplete revascularization and are likely to disbar. Defects which are unchanged with effort, may be permitted in the context of previou s myocardial infarction. Drug- treatment for the management of symptoms sho uld disbar. Angioplasty for multivessel coronary artery disease, sequential angioplasty and/or angioplasty of a graft carries a higher event rate, even after 6 mo nths, than is likely to be acceptable. A major trial, the Surgery or Stent (SOS) trial comparing stenting with surgery of multi-vessel coronary artery disease, is at present underway and the outcome is awaited.