Characteristics of Patients with Wellens Syndrome Who Underwent Coronary Angiogram: A Single Center Experience

Abstract

Introduction: Wellens syndrome refers to a characteristic set of ECG abnormalities associated with simultaneous severe stenosis of the proximal part of the left anterior descending artery (LAD). Early intervention with percutaneous coronary intervention (PCI) is paramount otherwise may result in anterior wall myocardial infarction or even death.Objectives: The major objective of this study was to determine the clinical, echocardiographic and angiographic features which are specific to Wellens syndrome in order to diagnose the patients and manage them urgently to reduce morbidity and mortality.Methodology: 52 patients with Wellens syndrome were recruited for a descriptive cross-sectional study conducted in the cardiology unit of the National Hospital of Kandy, Sri Lanka. All the recruited patients underwent serial ECGs, blood for cardiac markers, and a comprehensive 2D echocardiogram within 24 hours of admission. An interviewer-administered questionnaire was used for data collection and all the data was analyzed by statistical package for the social sciences (SPSS) 23 software.Results: The majority of affected patients were males (71.2%). More than half of the participants had very severe stenosis of LAD (52.1%), one-fifth of them had severe stenosis (22.9%), and about one-third were suffering from triple vessel disease (TVD: 32.69%) according to the angiogram. Characteristically, 83% of diagnosed patients with Wellens syndrome had not complained of any pain during their diagnostic ECG tracing and the majority had normal cardiac troponin levels (82.7%) at the presentation.Conclusions: Even though the ECG findings of Wellens syndrome are highly specific (89%), due to either normal or slightly elevated levels of cardiac markers and the pain-free status of the patients at the presentation often mislead the physicians. Late diagnosis may result in extensive myocardial damage and even death. Therefore, early identification and intervention is vital.