Wellens’ Syndrome, Is the Left Anterior Descending Artery the Only Causing Vessel? | ||
| Zagazig University Medical Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 13 October 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/zumj.2025.421934.4172 | ||
| Authors | ||
| Ahmed Fathy Ahmed1; Mohammad Gouda Mohammad2; Mohamed Elsayed Abdelfattah Ali* 3; Doaa Mohamed Elsayed Abdelghafar4 | ||
| 1Professor of Cardiology Medicine, Faculty of Medicine, Zagazig University, Egypt | ||
| 2Professor of Cardiology , Faculty of Medicine, Zagazig University, Egypt. | ||
| 3Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt | ||
| 4Lecturer of Cardiology, Faculty of Medicine, Zagazig University, Egypt. | ||
| Abstract | ||
| Background: Wellens’ syndrome is classically described as a clinical and electrocardiographic marker of critical stenosis of the proximal left anterior descending (LAD) artery. However, emerging evidence suggests that similar electrocardiographic patterns may also be observed in association with lesions in other coronary territories. This study aimed to evaluate whether Wellens’ syndrome can be attributed exclusively to LAD stenosis, or whether culprit lesions may also be identified in other coronary vessels. Methods: This cross-sectional study included 130 consecutive patients with Wellens’ syndrome admitted for primary percutaneous coronary intervention (PCI), patients were stratified into three groups: Group A (isolated LAD lesions, n=55), Group B (isolated RCA or LCx lesions, n=10), and Group C (multivessel disease including LAD, n=65). All underwent clinical evaluation, laboratory testing, electrocardiography, echocardiography, and coronary angiography. Results: The mean age was 58.9±10.5 years, with male predominance (77.7%). Patients with non-LAD lesions (Group B) were significantly younger compared to LAD and multivessel groups (46.6±11.3vs 58.8±10.9 and 60.9±8.9years, p<0.001). A significant difference in family history was noted (p=0.015), highest in Group B (20%). No significant differences were observed regarding hypertension, diabetes, smoking, or hyperlipidemia. Coronary angiography confirmed that, while LAD was most frequently involved, a subset of patients demonstrated RCA or LCx lesions producing Wellens-like ECG changes. Conclusion: Wellens’ syndrome, although strongly associated with proximal LAD stenosis, is not limited to this vessel. RCA and LCx lesions may occasionally present with the classical ECG pattern. Early coronary angiography is essential in all suspected cases to ensure accurate diagnosis and timely revascularization. | ||
| Keywords | ||
| Wellens’ syndrome; Left anterior descending artery; Right coronary artery; Acute coronary syndrome; Coronary angiography | ||
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