P6411Achilles tendon thickening as an independent predictor for advanced coronary artery disease in patients without diagnosed familial hypercholesterolemia undergoing percutaneous coronary intervention

Background: Although tendon xanthoma, represented as Achilles tendon thickening (ATT), is one of the important diagnostic criteria for familial hypercholesterolemia (FH), there are some cases with ATT who do not meet these criteria in patients with coronary artery disease (CAD). Purpose: The purpose of this study was to investigate the severity of CAD in non-FH patients with ATT undergoing percutaneous coronary intervention (PCI). Methods: Patients with CAD undergoing PCI at our University Hospital between June 2016 and Dec 2017 were enrolled. FH patients diagnosed according to the Simon Broom criteria and post-CABG patients were excluded. Soft x-ray radiography of the Achilles tendon was performed, and a maximum thickness of 9 mm or more was regarded as ATT. CAD severity was assessed by SYNTAX score before the first PCI during the study period. Results: In a total of 350 patients enrolled, 32 patients (9.1%) had ATT. The overall SYNTAX score was 13.5±8.2, and 47 patients (13.4%) showed intermediate or high SYNTAX score (≥23). The ATT group had higher BMI (p=0.001), and the higher prevalence of prior myocardial infarction (p=0.027), acute coronary syndrome at the first PCI (p=0.004), and multivessel disease (p=0.008), compared to the non-ATT group. SYNTAX score was significantly higher in the ATT group, compared to the non-ATT group (Figure). Multivariate logistic regression analysis determined ATT (p<0.001), family history of CAD (p=0.021), and lower ejection fraction (p=0.032) as independent predictors for higher SYNTAX score (≥23).