The relationship between no-reflow phenomenon and achilles tendon thickness in patients undergoing coronary angiography for acute coronary syndrome

INTRODUCTION AND OBJECTIVE: Elevated LDL cholesterol levels are associated with Achilles tendon thickening (ATT) and widespread atherosclerotic coronary artery disease. Severe atherosclerosis increases the risk of the no-reflow phenomenon (NRF) during coronary interventions. This study aimed to investigate the relationship between ATT and NRF in patients with acute coronary syndrome. METHODS: Between January 2021 and January 2024, 5,980 patients with acute coronary syndrome were treated in our hospital's coronary intensive care unit. Of these, 164 patients with lateral ankle radiographs were included. Patients were divided into two groups: 56 with NRF and 108 without. ATT was measured by a radiologist, blinded to clinical data, using lateral ankle radiographs. The NRF diagnosis was based on TIMI, TMP, and MBG classification systems. Baseline clinical data were collected and analyzed. RESULTS: No significant relationship was found between ATT and NRF incidence. However, significant differences were noted between the groups in terms of age, obesity, and hyperlipidemia history. The NRF group was older (p = 0.018), had a higher obesity prevalence (p = 0.025), and a higher rate of hyperlipidemia (p = 0.001). The Syntax score was significantly higher in the NRF group (19.9 ± 9.5 vs. 14.8 ± 8.1; p = 0.001). Ejection fraction post-PCI was lower in the NRF group (45 ± 9.2 vs. 48 ± 9.2; p = 0.034). The number of stents placed (p = 0.006), total stent length (30.8 ± 12.3 vs. 40.8 ± 15.2; p < 0.001), stent implantation pressure (16.2 ± 1.2 vs. 17.2 ± 1.0; p = 0.004), postdilatation (45 [41.7] vs. 38 [69.1]; p = 0.001), and postdilatation balloon length (3.5 [3-3.5] vs. 3.5 [3-3.5]; p = 0.039) were all significantly higher in the NRF group. Use of thrombectomy and tirofiban infusion was more frequent in the NRF group (p < 0.001). Independent factors associated with NRF were higher Syntax score (p = 0.007), hyperlipidemia history (p = 0.040), and longer postdilatation balloon length (p = 0.016), as shown by regression analysis. CONCLUSION: No direct relationship was found between ATT and NRF. However, the lower mean ATT in the NRF group suggests that further studies with larger sample sizes could provide more definitive results.