Beyond A and B: exploring a novel dynamic electrocardiogram change in Wellens syndrome
- retrospective single-centre study
- consecutive patients
- ECGs reviewed by two cardiologists blinded to angiographic findings
+2 more
- consecutive patients
- ECGs reviewed by two cardiologists blinded to angiographic findings
Authors' conclusion
In this cohort of patients with confirmed Wellens syndrome, Pattern A-to-B evolution occurred in approximately one-third of patients before coronary angiography, suggesting that dynamic ECG evolution occurs during the acute phase. Further studies are warranted to determine its diagnostic, prognostic, and therapeutic implications.
Study context
- Population
- Patients with Wellens syndrome and angiographic confirmation of significant left anterior descending (LAD) disease (≥70% stenosis)consecutive patients with Wellens syndrome, 18 with Pattern A-to-B evolution
- Participants
- 51 patients
Main finding
As reported in the abstract
Evolution from Pattern A to Pattern B before angiography · first 24 h
Patients with documented evolution
Eighteen patients (35.3%)
Within 6 h of admission
Fourteen
Between 6 and 24 h
four
Observational data: associations, not effects.
Further findings
Characteristics of patients with Pattern A-to-B evolution
- Median left ventricular ejection fraction
- 53% (Interquartile Range [IQR], 46-60)
- High-sensitivity cardiac troponin elevated
- 12 patients (66.7%)
- Isolated LAD involvement
- 10
- Multivessel disease
- eight
- Percutaneous coronary intervention (PCI)
- 10
- Characteristics of patients with Wellens syndrome (n=51): Left anterior descending disease confirmed in all patients
- Characteristics of the overall cohort (not specifically Pattern A-to-B evolution patients): Revascularization in 13 patients (10 PCI, 3 CABG)
- Revascularization in this cohort: coronary artery bypass grafting performed in three patients
- All PCI procedures achieved Thrombolysis in Myocardial Infarction (TIMI) 3 flow
Safety
In-hospital deaths or major adverse cardiovascular events
- No in-hospital deaths or major adverse cardiovascular events occurred
Original publication
Beyond A and B: exploring a novel dynamic electrocardiogram change in Wellens syndrome. Eur Heart J Acute Cardiovasc Care. Published 24 July 2026. doi:10.1093/ehjacc/zuag102
Summarised from the published abstract; every number is checked against it