Abstract Body (Do not enter title and authors here): Background: Lipid-lowering therapy (LLT) is a primary means of secondary prevention in patients with acute coronary syndrome (ACS) and the current guidelines recommend maximum tolerated statin and ezetimibe as LLT. Achilles tendon thickening (ATT) is one of the criteria for the diagnosis of familial hypercholesterolemia, which can sometimes be accompanied by ACS. However, the impact of ATT on the prognosis after ACS under the intensive LLT remains unclear.
Hypothesis: ACS patients with ATT would have worse prognosis even with receiving intensive LLT.
Aims: The aim of the current study was to compare the long-term prognosis of ACS patients with and without ATT.
Methods: We retrospectively analyzed 218 patients who underwent successful percutaneous coronary intervention for ACS and received the intensive LLT with maximum tolerated doses of statins and ezetimibe at our hospital from September 2017 to May 2023. Thickness of Achilles tendon was measured on radiography, and ATT was defined as Achilles tendon ≥8.0 mm in males and ≥7.5 mm in females. The cumulative incidence of 5-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction, target vessel revascularization, and stent thrombosis, was estimated by the log-rank test and was compared between the patients with and without ATT. Hazard ratio (HR) and 95% confidence interval (CI) of ATT for MACE were estimated through a multivariable Cox model.
Results: ATT was found in 58 patients (26.6%). The proportion of low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL was significantly lower in patients with ATT (45% vs. 77%, p<0.001). The 5-year cumulative incidence of MACE was significantly higher in patients with ATT than those without ATT (22.2% vs. 7.6%, p=0.021, Figure). Multivariate analysis showed ATT significantly impacted on the incidence of MACE (HR 3.13, 95% CI 1.18-8.31, p=0.022).
Conclusions: ATT was associated with lower achievement rate of target LDL-C level and worse long-term clinical outcomes in patients with ACS receiving intensive LLT, which suggests more intensive lipid management including the introduction for proprotein convertase subtilisin/kexin type 9 inhibitor in patients with ATT.