Characteristics of Wellens’ Syndrome in the Current PCI Era: A Single-Center Retrospective Study

Abstract

Objectives. The goal of this retrospective study was to reveal the prevalence, angiographic characteristics, clinical presentation, and long-term outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) patients with Wellens’ syndrome. Background. Procedural results for percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) have improved in recent years. However, there is still a paucity of available clinical trial data for Wellens’ syndrome even though it is a well-known high-risk ACS. Methods. Among a total of 3528 patients with ACS who underwent angioplasty from 2017 to 2019 at the Cardiovascular Center of Beijing Friendship Hospital, 476 NSTEMI patients with culprit left anterior descending (LAD) vessels were enrolled in this study. According to electrocardiographic criteria of Wellens’ syndrome, the patients were divided into a Wellens group (n = 138) and a non-Wellens group (n = 338). The primary endpoint was cardiac death; the secondary endpoints were main adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause death, cardiac death, heart failure, target lesion revascularization, recurrent myocardial infarction, and stroke. All of the medical and follow-up data were obtained from our institutional database. Results. The incidence of Wellens’ syndrome in all ACS patients was 5.7% (200 of 3528). Among the 200 patients with Wellens’ syndrome, 138 had NSTEMI, for a proportion of 69%. There was a significant decrease in the percentage of preexisting coronary heart disease (CHD), prior myocardial infarction, and previous PCI ( P < 0.05 ) in the Wellens group compared with the non-Wellens group. On coronary angiography, single-vessel lesions were more common in the Wellens group (11.6% vs. 5.3%, P = 0.016 ), and almost all (97.1%) of these patients received drug-eluting stents. Notably, the Wellens group had a higher proportion of early PCI than the non-Wellens group (71% vs. 61.2%, P = 0.044 ). At 24 months, there was no statistically significant difference in cardiac death ( P = 0.111 ) between the two groups, but the MACCEs were comparable (Wellens: 5.1% vs. non-Wellens: 13.3%, P = 0.009 ). Age ≥65 years was the largest independent risk factor for adverse prognosis. Conclusions. With early recognition and aggressive intervention, Wellens’ syndrome is no longer a risk factor for adverse prognosis in patients with NSTEMI in the current PCI era.

Síndrome de Wellens, algunas notas para no olvidarlo

“…1 Se describen dos variantes: la primera (tipo A) consiste en ondas T bifásicas en derivaciones V2 y V3, representando 24% de los casos; la segunda (tipo B) consiste en ondas T invertidas, simétricas y profundas en derivaciones V2 y V3, frecuente en V1 y V4 y ocasionalmente en V5 y V6. Los criterios diagnósticos son: antecedente de dolor precordial, elevación ligera de biomarcadores cardiacos o sin elevación, ausencia de ondas Q patológicas, ligera o nula elevación del segmento ST, ausencia de pérdida de ondas R. 1,2 Según la cuarta definición universal de infarto de miocardio, la ausencia de la elevación del ST en derivaciones precordiales y la inversión de ondas T simétricas y profundas (> 2 mm) deben ser considerados signos tempranos que preceden la elevación del segmento ST, por lo que previamente el síndrome se consideraba como un equivalente de infarto agudo de miocardio con elevación del segmento ST. Su prevalencia se estima alrededor de 10-15% de los casos de síndrome coronario agudo. 3 La presentación clínica no es específica; de manera más frecuente se presenta con angina, dolor precordial u opresión, mientras que síntomas atípicos se pre-sentan con más frecuencia en poblaciones especiales (diabéticos, adultos mayores, etcétera).…”

“…En general, los cambios en ondas T ocurren durante los periodos libres de dolor, habitualmente, por lo que en ocasiones no se detectan en un electrocardiograma. 1,2…”

Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing

“…These high-risk patterns on ECG can indicate a critical stenosis or occlusion of a coronary artery and should be evaluated with great vigilance, even if Tn is normal or mildly elevated. One such pattern is the T waves of Wellen’s syndrome [ 246 , 247 ]. Type 1 Wellen’s syndrome involves deep symmetric T-wave inversions in at least V2-V3 (though the involvement of V1-V6, aVL, and I is also possible).…”