Mid term outcomes in Wellens syndrome

Abstract

Background. Wellens syndrome (WS) has been described as a clinical and electrocardiographic (ECG) complex that identifies a subset of patients with unstable angina (UA) at an impending risk of myocardial infarction (MI) and death in studies published almost 4 decades ago, before the wide use of cardiac biomarkers such as troponins. The mid and long term outcomes of patients with Wellens syndrome have never been compared with a contemporary cohort of patients with non-ST elevation acute coronary syndromes (NSTEACS). Objectives. The primary endpoints of our study were the rate of cardiovascular rehospitalizations, the rate of ischaemic reccurences, the rate of subsequent or reccurent revascularization and the rate of mortality at six months from the index event. Materials and methods. We performed a prospective analysis of 64 consecutive patients with WS who underwent coronary angiography and we compared them with an age and sex matched cohort of patients with NSTEACS who underwent coronary angiography. The study took place at Bagsadar-Arseni Emergency Clinical Hospital and included a total of 127 patients recruited within 2 years (from January 2018 until December 2019), who were followed for a period of 6 months. Results. Within 6 months of follow-up, patients in the control group had a significantly higher rate of cardiovascular rehospitalizations (41.9% vs. 21.9%, p = 0.016), although the rate of ischaemic recurrences was similar between the 2 groups. Other interventional end-points, such as subsequent interventional revascularization, repeat interventional revascularization and repeat target vessel revascularization (TVR) were comparable between the 2 groups at 6 months follow-up. There was no significantly difference with respect to global mortality (6.3% in WS group vs. 7.9% in the control group, p = 0.74). Discussions. To our knowledge, this is the first prospective study with mid term follow up that compared a consecutive cohort of patients with WS who underwent coronary angiography with an age and sex matched cohort of patients with NSTEACS. Patients with WS had similar event rates with respect to ischaemic recurrences, subsequent or repeat interventional revascularization and repeat target vessel revascularization (TVR) and mortality rate at 6 months, although significantly more patients in WS group were considered at low risk. Conclusions. Wellens sign is frequently overlooked in the emergency department and risk assessment based on risk scores is frequently misleading. Prompt recognition of subtle ECG ischaemic changes, such as WS, in patients with chest pain is crucial, as it reflects a large area of myocardium at risk and identifies a subgroup of patients who can benefit from early invasive management.

Keywords

• acute coronary syndrome
• wellens syndrome
• risk stratification
• revascularization
• mortality