Clinical Characteristics of Wellens' Syndrome: A Retrospective Observational Study

Choi, Han Joo

Abstract

PURPOSE
Wellens' syndrome (WS) is characterized by specific T wave changes on precordial leads with atypical presentation of chest pain. We aimed to evaluate the clinical characteristics of WS, including proportion, echocardiographic findings, and progress among patients with unstable angina who visited the emergency room.
METHODS
A retrospective design was used in conduct of this study. We reviewed medical records, echocardiographic reports, and coronary angiographic findings of patients with unstable angina diagnosed during a period of two years (from August 2008 to August 2010).
RESULTS
Proportion of WS was 7.5%(15 patients) of initial patients diagnosed as unstable angina. The proportion of males was 40%. Mean age of patients was 63 years. More than 50% LAD stenosis was observed in every case (mean stenotic area was 78%), and 67% of patients suffered from multi-vessel diseases. Serum troponin-I level of type II (characterized as deep inverted T) was higher, compared with that of type I (characterized as biphasic T wave at V2-3) (p=0.02). Ejection fraction of type II was lower than that of type I (p=0.04); 27% of WS patients progressed to myocardial infarction (one patient was ST segment elevation myocardial infarction).
CONCLUSION
Emergency physicians should have knowledge of the specific electrocardiographic findings of WS, as well as associated clinical features. Early coronary artery intervention should be considered in order to prevent worsening to myocardial infarction.