Prevalence and Clinical and Angiographic Features of Wellens Syndrome in Patients with Acute Coronary Syndrome

Aim. To evaluate the incidence, clinical, anamnestic, and angiographic characteristics of patients with Wellens syndrome (WS) in the profile of non-ST segment elevation myocardial infarction (NSTEMI).

Materials and methods. A retrospective, single-center study was conducted at the Regional Vascular Center No. 2 of the Novosibirsk Regional Clinical Hospital. It included 147 patients hospitalized with a diagnosis of NSTEMI in 2024. Of those, 21 patients (14.3%) had a verified WS ECG pattern (8 had type A, 13 had type B). All patients underwent coronary angiography (CAG).

Results. The age of patients with WS was 64 [57; 72] years, 66.7% were men. All patients had a history of hypertension, 38% had type 2 diabetes mellitus, and 76% had dyslipidemia. Despite the high cardiovascular risk, only 47% of patients received regular antihypertensive therapy, 28% received antiplatelet agents, and 19% – statins before hospitalization. Troponin I levels were elevated in 85% of patients (2.55 [1.9; 3.3] ng/ml). Clinically, spontaneous resolution of chest pain was noted in 50% of cases, recurrence occurred in 60% of patients, and absence of pain was noted in 10% of cases. According to CAG findings, critical stenosis (>90%) of the anterior descending artery was detected in 90% of patients. In two-thirds of the patients, the GRACE score indicated a high risk of in-hospital mortality.

Conclusion. WS was detected in one out of seven patients with NSTEMI and was associated with an extremely high risk of adverse events. Key clinical features include severe polymorbidity due to inadequate basic drug therapy, frequent recurrence, or absence of pain, which complicates timely diagnosis. Detection of characteristic ECG changes is an absolute indication for emergency CAG and revascularization.

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