70 Retrospective analysis of acute coronary syndrome (ACS) presenting with wellen’s pattern on electrocardiography (ECG)

Introduction Wellen's syndrome is an Acute coronary syndrome with a pattern of electrocardiographic (ECG) changes showing deeply inverted or biphasic T waves in anterior chest leads V2-V3, Highly specific for severe, proximal stenosis of the left anterior descending (LAD) coronary artery. A temporary obstruction of the LAD coronary artery usually, by the rupture of an atherosclerotic plaque leading to LAD occlusion, with subsequent clot lysis or other disruption of the occlusion before complete myocardial infarction has taken place. If not recognised early and properly treated, it tends to progress to a large acute anterior wall myocardial infarction, which can lead to substantial morbidity and mortality. The prognosis if managed with surgery or PCI is good, but it is poor if treatment is delayed or medical therapy is undertaken. Aims and objective To study clinical profile of Wellen's syndrome To assess their biochemical, echocardiographic and angiographic results To analyze management pathway for Wellen's syndrome To assess clinical and echocardiographic outcome Study design Retrospective analysis of acute coronary syndrome patients presenting with Wellen's syndrome on ECG, undergoing invasive coronary angiography in a Primary PCI centre (District general hospital) in the UK in six months period. Inclusion criteria ACS with presenting ECG showing Wellen's pattern Age more than 18 years Exclusion criteria Not suitable or consenting for coronary angiography Previous anterior wall myocardial infarction or any coronary intervention to Left Anterior Descending artery (LAD) in past including bypass graft Any history of cardiomyopathy with reduced ejection fraction Methodology Retrospective analysis of referral notes, case files, echocardiography reports and angiographic results of patients presenting to hospital with Wellen's syndrome ECG on presentation and at the time of catheterisation were noted Results Total 18 patients were identified to have Wellen's syndrome in the study period of six months. Mean age was 62 years, median age being 61.6 years Oldest patient was 82 yrs old and youngest was 49 years old. Male:female ratio = 15:3 Two patients(11.11%) developed Q wave in anterior chest lead on the day of procedure 17 patients had troponin rise Nine patients (50%) were referred as STEMI and other half were referred as NSTEMI. Six patients(33.33%) presented more than 24 hours after start of chest pain. Most common reason for delay in seeking medical help was intermittent pain or pain free state. 11 patients(61.11%) had to wait for more than 24 hours for reach Cath lab after presentation to hospital. Most common reason was waiting list. So only five patient(27.77%) could reach Cath lab within 24 hours of start of the chest pain. Severe proximal LAD lesion was found in 16 patients(88.88%). 15 patients underwent percutaneous coronary intervention with stenting to LAD and one needing robotic LIMA graft to LAD. Severe Left Ventricular systolic dysfunction (LVEFConclusions A large proportion of Wellen's syndrome patients have left ventricular systolic dysfunction corresponding to LAD territory at the time of presentation. One peculiarity about this syndrome is intermittent pain or intervals of pain free period which is main cause of delay in presentation to hospital. As these patients do not meet criteria for STEMI, many a times they are put in a waiting list for Cath lab delaying revascularization. There is need for education and training emphasising the importance of triaging Wellen's syndrome so that these patients reach cath lab early. This will reduce chances of residual left ventricular systolic dysfunction and burden of heart failure. Conflict of Interest None