Air Travel After Recent Myocardial Infarction
In addition to concern over the risks of ischemia in flight, a number of travelers experience MI while abroad or in close proximity to planned travel. The American Medical Association (AMA) commission on Emergency Medical Services recommended in 1982 that travelers abstain from flying within 3 weeks of an MI. Major advances in angioplasty and coronary revascularization have occurred since the publication of these guidelines and should prompt a re-examination of prior recommendations. The American College of Cardiology recommends a 2-week waiting period prior to travel after an uncomplicated MI.
Very few studies have evaluated the safety of air travel following MI. Cox et al. undertook the most extensive examination of the topic in their study of 196 patients with recent MI transported by two medical assistance companies on commercial airliners from December 1986 to October 1989. The majority of patients were men, with a mean age of 63 years. Electrocardiographic localization of the infarction was available for 93% of patients, although peak creatinine kinase values were not provided. Forty-five percent of patients suffered anterior circulation infarctions, whereas 34% of infarcts were localized to the inferior circulation by ECG. Only 4.1% of the patients underwent angioplasty or coronary bypass surgery. Medication data were available for 147 of the 196 study patients. Fifty-six patients were taking aspirin and 32 were taking beta-blockers at the time of transport. Nine patients required physician intervention during the flight. Of these nine, six undertook travel less than 14 days after MI. Cox et al. concluded that air travel may be safely undertaken within 2 to 3 weeks of MI when an accompanying physician is present. Zahger et al. came to a similar conclusion in their small study of 17 patients who suffered acute MI in Israel between May 1996 and May 1999. All patients were risk stratified and offered intervention when appropriate. Seven patients underwent angiography and five were revascularized. Patients flew home 18±11 days after admission. Only five flew with medical escorts, and none of the original 17 patients experienced significant in-flight events.
Roby et al. studied 38 patients who chose to fly within a mean 15 to 16 days of acute uncomplicated MI between January 1993 and February 1996. The authors excluded those patients who suffered a complicated infarction defined as the presence of postinfarct angina, arrhythmia, or left ventricular dysfunction lasting for more than several days. Thirty-four of 38 patients had suffered Q-wave infarction, with mean creatinine kinase levels of 866U/L in the intervention group and 1,217U/L in the control group. Both groups were accompanied by physician escorts. All patients underwent continuous holter monitoring and oxygen saturation monitoring during flight. The intervention group received 2L of supplemental oxygen by nasal canula in flight. Only one patient had electrocardiographic evidence of ischemia in flight, whereas five patients had transient oxygen saturation below 90%, and five patients had ventricular ectopy with no episodes of sustained ventricular tachycardia.
These data suggest that air travel 2 to 3 weeks after an acute MI is reasonably safe when appropriate revascularization or angiography has been undertaken in high-risk patients. Medical escort may not be necessary. Placement of intracoronary stents should not result in activation of airport security systems. The increasing availability of AEDs on commercial flights may provide an increased measure of security for those who suffer from ventricular fibrillation during air travel. Evaluations of the use of AEDs on board US aircraft show survival rates for resuscitation ranging from 27% to 40%.
J Travel Med. 2004;11(4) © 2004 International Society of Travel Medicine
Cite this: Air Travel and Cardiovascular Disease - Medscape - Aug 01, 2004.