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FH (<jats:italic>n<\/jats:italic>\u2009=\u2009120) was diagnosed using Dutch Lipid Clinic Network criteria (score\u2009\u2265\u20096). We compared the angiographic features of MI patients with and without FH (score 0\u20132) (<jats:italic>n<\/jats:italic>\u2009=\u2009234) after matching for age, sex, and diabetes (1:2).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Although LDL-cholesterol was high (208 [174\u2013239] mg\/dl), less than half of FH patients had chronic statin treatment. When compared with non-FH patients, FH increased the extent of CAD (as assessed by SYNTAX score; <jats:italic>P<\/jats:italic>\u2009=\u20090.005), and was associated with more frequent multivessel disease (<jats:italic>P<\/jats:italic>\u2009=\u20090.004), multiple complex lesions (<jats:italic>P<\/jats:italic>\u2009=\u20090.022) and significant stenosis location on left circumflex and right coronary arteries. Moreover, FH patients had more multiple lesions, with an increased rate of bifurcation lesions or calcifications (<jats:italic>P<\/jats:italic>\u2009=\u20090.021 and <jats:italic>P<\/jats:italic>\u2009=\u20090.036, respectively). In multivariate analysis, LDL-cholesterol levels (OR 1.948; 95% CI 1.090\u20133.480, <jats:italic>P<\/jats:italic>\u2009=\u20090.024) remained an independent estimator of anatomical complexity of coronary lesions, in addition to age (OR 1.035; 95% CI 1.014\u20131.057, <jats:italic>P<\/jats:italic>\u2009=\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>FH patients with acute MI had more severe CAD, characterized by complex anatomical features that are mainly dependent on the LDL-cholesterol burden. Our findings reinforce the need for more aggressive preventive strategies in these high-risk patients, and for intensive lipid-lowering therapy as secondary prevention.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12944-021-01467-z","type":"journal-article","created":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T09:03:27Z","timestamp":1620119007000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Coronary lesion complexity in patients with heterozygous familial hypercholesterolemia hospitalized for acute myocardial infarction: data from the RICO survey"],"prefix":"10.1186","volume":"20","author":[{"given":"Hermann","family":"Yao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Farnier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Tribouillard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Chague","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Brunel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maud","family":"Maza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damien","family":"Brunet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luc","family":"Rochette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florence","family":"Bichat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yves","family":"Cottin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5763-4579","authenticated-orcid":false,"given":"Marianne","family":"Zeller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,4]]},"reference":[{"issue":"45","key":"1467_CR1","doi-asserted-by":"publisher","first-page":"3478","DOI":"10.1093\/eurheartj\/eht273","volume":"34","author":"BG Nordestgaard","year":"2013","unstructured":"Nordestgaard BG, Chapman MJ, Humphries SE, Ginsberg HN, Masana L, Descamps OS, et al. 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