The Comparative Assessment of Wellens' Syndrome With Proximal Left Anterior Descending Artery (LAD) Stenosis Versus Right Coronary Artery (RCA) or Circumflex Coronary Artery Stenosis and Its Prevalence: A Systematic Review

Abstract

Wellens' syndrome is well-known for its critical stenosis of the proximal left anterior descending artery (LAD) with characteristic electrocardiographic findings of biphasic or deeply inverted T waves in V2-V6 under specific diagnostic criteria. Although the syndrome is known as a high-grade LAD lesion, its sequence of events can also be seen with the right coronary artery (RCA) and the left circumflex artery (LCX). This systemic review attempts to expand on these findings while analyzing the prevalence of Wellens' syndrome with the RCA and/or the circumflex artery. This study also comparatively indicated that Wellens' syndrome is seen in RCA and circumflex artery stenoses when present; the indication of the same medical management is warranted for effective treatment and survival. We extracted and analyzed 24 case reports each with an atypical presentation of acute coronary syndrome (ACS) and specific Wellens' syndrome pattern of electrocardiogram (ECG) presentation with critical stenosis in the LAD, RCA, and left circumflex artery. The risk of bias assessment was undertaken using internal risk analysis by utilizing medical libraries and certain search phrases to find research articles with the involvement of the LAD as opposed to the RCA and LCX in Wellens' syndrome. Based on the number of respective primary research articles found, a bias calculation was done on the reported respective coronary artery involvement. The finding of our systemic review confirms that Wellens' syndrome is a precordial lead disease with T wave abnormalities that present with critical stenosis of not only the LAD but also the RCA and circumflex artery. The result of our systemic review affirmed that although most Wellens' syndrome cases reported involve the stenosis of the LAD, the critical occlusion of the RCA and/or the circumflex artery was found with Wellens' syndrome pattern of ECG presentation, meaning that the sequence of events is not limited to the proximal LAD.

Keywords: left anterior descending artery (lad); left circumflex artery; proximal stenosis; right coronary artery; t wave pattern; wellens’ syndrome.

Figure 1. Risk of bias assessment of reported cases

Figure 2. Reported cases: risk of bias assessment

Arshad et al. (2020) [3], Nagdev et al. (2022) [4], Khattar et al. (2023) [5], Wang et al. (2018) [6], Jayasekara and Weerakoon (2016) [7], Parekh et al. (2022) [8], Kim et al. (2020) [9], Avram et al. (2021) [10], Jaiswal and Boudreau (2016) [11], Natarajan (2020) [12], Elkholy et al. (2021) [13], Ajibawo et al. (2020) [14], Torelli et al. (2020) [15], Di Stolfo et al. (2015) [16], Mufti et al. (2018) [17], Yazdi and Sharim (2019) [18], Yang et al. (2023) [19], Plappert et al. (2022) [20], Tan et al. (2017) [21], Khan et al. (2013) [22], Shah et al. (2021) [23], Hollar et al. (2015) [24], Obi et al. (2023) [25], Mathew et al. [2]

Figure 3. PRISMA flow diagram of the study screening process

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses