Association Between Achilles Tendon Thickness as Assessed by Ultrasound and Coronary Artery Disease Severity in Patients Undergoing Percutaneous Coronary Intervention

Previous studies reported a significant association between Achilles tendon (AT) xanthoma (ATX) as assessed by radiography and coronary artery disease (CAD) severity. In contrast to radiography, ultrasonography can provide more accurate measurement of the AT thickness (ATT). This study aimed to investigate the association between ATT as assessed by ultrasonography and CAD severity. In the present cross-sectional study, we analyzed 176 patients undergoing percutaneous coronary intervention (PCI) and ATT assessment between May 2023 and April 2025. ATT was measured by ultrasound and ATX was defined as ≥6.0 mm in men and ≥5.5 mm in women. The SYNTAX score was calculated based on coronary angiography prior to PCI. SYNTAX score was significantly higher in patients with ATX (n = 62) compared with those without ATX (n = 114) (22.3 ± 7.9 vs 14.4 ± 8.3, P < .001). ATT was significantly correlated with SYNTAX score (r = 0.324, P < .001). A significant correlation between ATT and SYNTAX score was observed in patients without prior statin therapy (r = 0.485, P < .001), whereas no such correlation was observed in those with prior statin therapy (r = 0.092, P = .466). In conclusion, ATT as assessed by ultrasound was significantly correlated with CAD severity. Prior statin treatment significantly impacted on the association between ATT and CAD severity (Achilles study, UMIN 000053786).