Significance of Wellens Pattern in Electrocardiogram Revisited – Electrocardiogram and Angiographic Correlation

Abstract

Abstract Background: In patients with non-ST elevation acute coronary syndrome (NSTEACS), electrocardiogram (ECG) may show deep or biphasic T-wave inversions in precordial leads. Previous reports had linked this ECG change with a lesion in the left anterior descending artery (LAD). However, it is often overlooked in the emergency department and is not included in the major scoring systems for risk stratification of acute coronary syndrome. Objectives: We assessed coronary angiogram (CAG) lesions in patients with biphasic T inversion and/or deep T inversions by ECG. Methods: From July 2019 to November 2021, ECGs of all NSTEACS patients were analyzed and 202 patients who satisfied the criteria were chosen. CAGs were analyzed for the site, severity, and type of lesion. Treatment modality advice was noted. Results: One hundred and ninety-five patients had severe disease in the LAD, of which 178 patients had a lesion proximal to the first septal perforator branch. LAD lesions were discrete in 98, tubular in 68, diffuse in 25, and total occlusion in 11 patients. One hundred and thirty-four patients were advised to have percutaneous coronary intervention (PCI) as treatment. Sixty-three patients with a severe lesion had no recurrent angina and 103 were negative for troponin. Conclusion: 96.5% of patients with NSTEACS and an ECG abnormality had a significant lesion in the LAD. In 88.1% of patients, the lesion was before the first septal perforator branch. Overall, 66.3% of patients were advised to undergo PCI. The sensitivity of troponin in predicting severe lesion was 47.7%, and the sensitivity of recurrent angina was 67.7% only. This ECG abnormality by itself, even without recurrent angina or troponin elevation, should be an indication for invasive evaluation such as CAG.