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

• Published in: BMC cardiovascular disorders Vol. 22; no. 1; pp. 176 - 8
• Main Authors: Zhou, Li, Gong, Xuhe, Dong, Tianhui, Cui, He-he, Chen, Hui, Li, Hongwei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.04.2022; BioMed Central; BMC
• Subjects: Acute coronary syndrome; Acute coronary syndromes; Aged; Angioplasty; Biomarkers; Body mass index; Cardiac death; Cardiovascular disease; Care and treatment; Cerebral infarction; Clinical outcomes; Congestive heart failure; Coronary Artery Disease; Death; Diabetes; Diabetes mellitus; Diagnosis; Heart attack; Heart attacks; Hospitals; Humans; Hypertension; Incidence; MACCE; Medical prognosis; Medical records; Myocardial infarction; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - epidemiology; Non-ST Elevated Myocardial Infarction - therapy; NSTE-ACS; Patient outcomes; Patients; Percutaneous Coronary Intervention - adverse effects; Prevention; Regression analysis; Risk factors; Smoking; Stroke; Syndrome; Wellens’ syndrome; China; Beijing China; MACCE; Wellens’ syndrome; NSTE-ACS; Angioplasty; Cardiac death
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02560-6

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. 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. 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). 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.