Background Wellens syndrome is a clinical, biological, and electrocardiographic complex that identifies a subgroup of patients with unstable angina who have an impending risk of myocardial infarction and death, representing an equivalent of ST segment elevation myocardial infarction. Methods We conducted a prospective analysis of 64 consecutive patients, recruited over 2 years, with Wellens syndrome who underwent coronary angiography and we compared them with an age- and sex-matched group of patients with non-ST segment elevation acute coronary syndrome who underwent coronary angiography. The primary endpoints of our study were the rate of cardiovascular rehospitalizations, the rate of ischaemic reccurences, the rate of subsequent or recurrent revascularization, and the rate of mortality at six months from the index event. Results At 6 months, the patients in the control group had a higher rate of cardiovascular rehospitalizations (41.9% vs. 21.9%, p = 0.016). The rate of ischaemic recurrences and the rate of global mortality were similar across the two groups. Conclusion Physiopathologically and angiographically, Wellens syndrome is an abortive form of ST segment elevation myocardial infarction, but electrocardiographically and prognostically, it evolves similarly to a non-ST segment elevation acute coronary syndrome.
Despite continuous efforts in early recognition and timely management, acute coronary syndromes (ACS) continue to be the most common cause of death worldwide. The electrocardiogram (ECG) is the fastest, repeatable and most accesible instrument with diagnostic value, prognostic significance and therapeutic implications. Based on the ECG, ACS are divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation ACS (NSTEACS). Current guidelines recommend emergency reperfusion theraphy only in patients with STEMI. Conventional criteria for the diagnosis of STEMI exclude the patients with atypical ECG findings, correlated with an increased risk of transmural myocardial infarction and considered STEMI equivalents. These particular ECG phenotypes are: new or presumably new bundle branch block, ST segment elevation in aVR, isolated posterior myocardial infarction, de Winter T waves, Wellens syndrome and ischaemia induced Brugada phenocopy. Rapid risk stratification in patients with NSTEACS is crucial for adequate management. The particular ECG phenotypes discussed herein proove the need to redefine the signs of the present or iminent coronary artery occlusion, especially the left anterior descending (LAD) artery, because many patient may benefit from early invasive treatment instead of conservative pharmacological treatment.
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