Evolution of de Winter Into Wellens on Electrocardiogram—What Happened?

Zhu, Yuansong; Luo, Suxin; Huang, Bi

doi:10.1001/jamainternmed.2021.5734

Cited by 7 publications

(20 citation statements)

References 11 publications

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“…In Reply We appreciate the thoughtful comments by Dr Tsou and colleagues and Dr Yap in response to our article. 1 Together they raised 4 concerns about the study design in (1) confounding management for maternal conditions and (2) for other central nervous system active drugs, (3) typical vs atypical antipsychotics, and (4) dose-response effect.…”

Section: Sunn Hoah Kelvin Yap Bscmentioning

confidence: 99%

“…Second, the authors excluded participants receiving antidepressants or lithium. 1 A nationwide study examined the use of central nervous system active drugs during pregnancy, 4 and the 3 most commonly used drugs were antidepressants, opioids, and sedatives. Therefore, we encourage the authors to analyze the confounding effects of opioids and sedatives.…”

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confidence: 99%

“…Third, confounding factors, such as maternal smoking and alcohol and/or substance use, were not available in the database used by the study. 1 Heavy alcohol and substance use are tightly associated with a wide range of negative birth outcomes. 5 Because of the age gaps between the study's 1 siblings, use of sibling-matched analyses may not have been sufficient to account for the onset of alcohol or substance use in mothers with psychiatric conditions.…”

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confidence: 99%

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Prenatal Exposure to Antipsychotics−Handle With Caution

Yap

2022

JAMA Intern Med

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Section: Sunn Hoah Kelvin Yap Bscmentioning

confidence: 99%

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Prenatal Exposure to Antipsychotics−Handle With Caution

Yap

2022

JAMA Intern Med

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“…To the Editor In a recent meta-analysis, O'Fee and colleagues 1 found that nonfatal myocardial infarction (MI) was not a surrogate for all-cause and cardiovascular mortality in patients with or at risk for coronary artery disease. We praise the investigators for their endeavor; however, we believe some important limitations are worth highlighting.…”

Section: The Importance Of Using the Appropriate Model For Systematic...mentioning

confidence: 99%

“…4 Jorge Sanz-Sánchez, MD, PhD Eugene McFadden, MD Hector M. Garcia-Garcia, MD, PhD, MSc In Reply We appreciate the comments by Dr Sanz-Sánchez and colleagues on our recent meta-analysis. 1 Although most contemporary randomized clinical trials analyze the primary composite outcome using time-to-event methods, many of those trials also report the raw event rates of the individual components of the composite end points, including nonfatal myocardial infarction (MI) and all-cause mortality. In our analysis, we included only studies that either reported raw event rates of individual outcomes or provided those event rates to us by request.…”

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confidence: 99%

Urgent Intervention for Both de Winter and Wellens

Chen

2022

JAMA Intern Med

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To the Editor We read the case report by Zhu and colleagues 1 with great interest. The authors indicated that the "direct evolution from the de Winter to Wellens pattern has never been reported before." 1 However, using the search string de Winter[Title] AND Wellens [Title] in PubMed, we found 2 similar cases, one reported by Samadov and colleagues from Turkey in 2013 2,3 and the other by Li and colleagues from China in 2019. 4 Apparently, Zhu and colleagues 1 were not the first to report the evolution of de Winter syndrome into Wellens syndrome.We would like to address the similarities and differences between these de Winter-to-Wellens cases. All 3 cases began with acute chest pain and showed a de Winter pattern on the results of the electrocardiogram (ECG) taken at pain onset; the pattern then evolved into the Wellens pattern; and results of all 3 coronary angiograms suggested severe stenosis of the left anterior descending branch. However, it is worth noting that Samadov and colleagues 2,3 also captured normal ECG results during an interval when the patient was between de Winter and Wellens syndromes. Li and colleagues 4 also reported that ECG results showed the ST-segment returning to the isoelectric line before evolving into Wellens syndrome. These case reports further suggest a possible intermediate coronary spontaneous recanalization with subsequent reperfusion injury and myocardial stunning to develop the Wellens pattern. In addition, Samadov and colleagues 2,3 reported type I Wellens syndrome and Li and colleagues 4 reported type II Wellens syndrome; however, Zhu and colleagues 1 showed type II Wellens evolving into type I.In conclusion, both de Winter and Wellens syndromes are relatively rare and easily overlooked but characteristic of ECG manifestations indicating acute coronary syndromes. Both are clinically important to early identification of patients with high-risk acute coronary syndrome, and both require urgent intervention and treatment.

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