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. 2022 Apr 16;22(1):176.
doi: 10.1186/s12872-022-02560-6.

Wellens' syndrome: incidence, characteristics, and long-term clinical outcomes

Li Zhou #  1 , Xuhe Gong #  1 , Tianhui Dong  1 , He-He Cui  1 , Hui Chen  2 , Hongwei Li  1   3   4
Affiliations

Wellens' syndrome: incidence, characteristics, and long-term clinical outcomes

Li Zhou et al. BMC Cardiovasc Disord. .

Abstract

Background: Few studies with large sample sizes are available regarding patients with Wellens' syndrome. Therefore, we sought to assess the current incidence, risk factors, clinical presentation and long-term outcomes of this population.

Methods: Among a total of 3528 patients with ACS who underwent angioplasty from 2017 to 2019 in our centre, 2127 NSTE-ACS patients with culprit LAD vessels were enrolled in this study. According to electrocardiographic criteria, the patients were divided into a Wellens' group (n = 200) and non-Wellens' group (n = 1927). The primary endpoint was cardiac death; the secondary endpoint was MACCE, a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, heart failure and stroke.

Results: The incidence of Wellens' syndrome was 5.7% (200 of 3528) of all ACS patients. Wellens' syndrome more often manifested as NSTEMI (69% vs. 17.5%, P < 0.001). The percentages of preexisting coronary heart disease (39.6% vs. 23%) and previous PCI (19.5% vs. 9%) were significantly higher in the non-Wellens' group than in the Wellens' group (all P < 0.001). More importantly, the proportion of early PCI was higher in the Wellens' group (68% vs. 59.3%, P = 0.017). At a median follow-up of 24 months, Wellens' syndrome was not associated with an increased risk of MACCE (P = 0.05) or cardiac death (P = 0.188).

Conclusions: The presence of Wellens' syndrome is not definitively associated with adverse prognosis in patients with NSTE-ACS. Age ≥ 65 years, diabetes, NSTEMI, eGFR < 60 ml/min and left main disease are associated with the incidence of cardiac death. Early recognition and aggressive intervention are critical, as they may help to attenuate adverse outcomes.

Keywords: Angioplasty; Cardiac death; MACCE; NSTE-ACS; Wellens’ syndrome.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patient enrollment. ACS, acute coronary syndromes; PCI, percutaneous coronary intervention; LAD, left anterior descending arterial; STEMI, ST-elevation myocardial infarction; MACCE, major adverse cardiac and cerebrovascular events
Fig. 2
Fig. 2
Kaplan–Meier analysis of MACCE (secondary endpoint, panel A) and cardiac death (panel B) for overall patients stratified by Wellens’ syndrome (green line) and non-Wellens’ syndrome (red line)
Fig. 3
Fig. 3
Factors independently associated with MACCE and cardiac death in overall patients in multivariable Cox regression analysis
See this image and copyright information in PMC

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