Obi Mukosolu F, Namireddy Vikhyath, Noel Chelsea, O'Brien Aidan, Sharma Manjari, Frederick Ariel, De Gale Blossom, Ubhi Manveer, Cho Ryan
Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA.
Medicine, St. George's University School of Medicine, True Blue, GRD.
Cureus. 2023 Apr 22;15(4):e37991. doi: 10.7759/cureus.37991. eCollection 2023 Apr.
Wellens' syndrome is well-known for its critical stenosis of the proximal left anterior descending artery (LAD) with characteristic electrocardiographic findings of biphasic or deeply inverted T waves in V2-V6 under specific diagnostic criteria. Although the syndrome is known as a high-grade LAD lesion, its sequence of events can also be seen with the right coronary artery (RCA) and the left circumflex artery (LCX). This systemic review attempts to expand on these findings while analyzing the prevalence of Wellens' syndrome with the RCA and/or the circumflex artery. This study also comparatively indicated that Wellens' syndrome is seen in RCA and circumflex artery stenoses when present; the indication of the same medical management is warranted for effective treatment and survival. We extracted and analyzed 24 case reports each with an atypical presentation of acute coronary syndrome (ACS) and specific Wellens' syndrome pattern of electrocardiogram (ECG) presentation with critical stenosis in the LAD, RCA, and left circumflex artery. The risk of bias assessment was undertaken using internal risk analysis by utilizing medical libraries and certain search phrases to find research articles with the involvement of the LAD as opposed to the RCA and LCX in Wellens' syndrome. Based on the number of respective primary research articles found, a bias calculation was done on the reported respective coronary artery involvement. The finding of our systemic review confirms that Wellens' syndrome is a precordial lead disease with T wave abnormalities that present with critical stenosis of not only the LAD but also the RCA and circumflex artery. The result of our systemic review affirmed that although most Wellens' syndrome cases reported involve the stenosis of the LAD, the critical occlusion of the RCA and/or the circumflex artery was found with Wellens' syndrome pattern of ECG presentation, meaning that the sequence of events is not limited to the proximal LAD.
Wellens综合征以左前降支近端严重狭窄而闻名，在特定诊断标准下，V2-V6导联出现特征性的双相或深倒置T波心电图表现。尽管该综合征被认为是左前降支的高级别病变，但右冠状动脉（RCA）和左旋支（LCX）病变时也可出现相同的事件序列。本系统评价试图在分析Wellens综合征合并RCA和/或左旋支的患病率时，对这些发现进行扩展。本研究还比较表明，当存在RCA和左旋支狭窄时，也会出现Wellens综合征；为了有效治疗和提高生存率，采用相同的医疗管理方法是必要的。我们提取并分析了24例急性冠状动脉综合征（ACS）非典型表现及心电图（ECG）呈现特定Wellens综合征模式且左前降支、RCA和左旋支严重狭窄的病例报告。使用内部风险分析进行偏倚风险评估，通过医学图书馆和某些搜索词查找Wellens综合征中涉及左前降支而非RCA和LCX的研究文章。根据找到的各自的原始研究文章数量，对报告的相应冠状动脉受累情况进行偏倚计算。我们系统评价的结果证实，Wellens综合征是一种胸前导联疾病，伴有T波异常，不仅左前降支严重狭窄时会出现，RCA和左旋支严重狭窄时也会出现。我们系统评价的结果证实，尽管大多数报告的Wellens综合征病例涉及左前降支狭窄，但在心电图呈现Wellens综合征模式时发现了RCA和/或左旋支的严重闭塞，这意味着事件序列不仅限于左前降支近端。
