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Deeply inverted or biphasic T-waves in anterior leads, so-called Wellens’ sign, has been considered to represent impending ischemia in left anterior descending (LAD) territory. However, this electrocardiographic pattern may be observed in patients without a critical stenosis in LAD artery. We aimed to evaluate its prevalence, clinical significance and prognostic value of Wellens’ sign in patients with non-ST elevation myocardial infarction (NSTEMI).
We performed a retrospective analysis of 481 consecutive patients presenting with NSTEMI who underwent coronary angiography within five days after presentation. Patients with complete bundle branch block and ventricular paced rhythm were excluded. Electrocardiograms were interpreted in a blinded fashion. Wellens’ sign was defined as either there are deeply inverted T-waves (≥3.0mV) or biphasic T-waves in both lead V2 and V3. Patients were categorized into a Wellens group and control group. Baseline and angiographic characteristics, in-hospital revascularization procedures, in-hospital and 30-day major adverse cardiac event (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were compared between the two groups.
Among 424 patients included in the final analysis, 18 patients (4.2%) had Wellens’ sign. Among the 18 patients, 9 had a LAD culprit lesion (3 proximal, 5 mid, and 1 distal LAD), 2 had a non-LAD culprit lesion, and 4 patients had nonobstructive coronary artery disease. There was no significant difference in the rate of previous myocardial infarction or percutaneous coronary intervention between the patients with and without Wellens’ sign. Patients with Wellens’ sign had a higher prevalence of LAD culprit lesion (50% vs. 22.9%, p=0.008). Peak troponin I values were comparable between the two groups (median [interquartile]; 0.92 [0.13-3.7] ng/mL vs. 0.66 [0.10-5.39] ng/mL, p=0.80). There was no significant difference in the rate of Thrombolysis In Myocardial Infarction grade 0-1 flow (16.7% vs. 24.6%, p=0.44), and in-hospital revascularization (55.5% vs. 62.3%, p=0.56). At the 30-day follow-up, no significant difference was found in the rate of MACE between the two groups (0% vs. 4.2%, p=0.38).
Our study demonstrated that 1) Wellens’ sign was observed in 4.2 % in this cohort; 2) Wellens’ sign had a predictive value for LAD culprit lesion, but it was also observed in patients with non-LAD culprit lesions; and 3) Wellens’ sign did not have a short-term prognostic value among patients with NSTEMI.