Comparison Of Coronary Artery Lesions And Risk Assessments Between Patients With Type 1 And Type 2 Wellens' Syndrome

Background and PurposeWellens' syndrome,also called left anterior descending(LAD)coronary T-wave syndrome,is associated with severe coronary stenosis of the proximal LAD.It accounts for 14% to 18% of patients with unstable angina and also can be seen in patients with non-ST-elevation myocardial infarction(NSTEMI)and spasm of LAD.Wellens' syndrome is divided into type 1 Wellens' syndrome(WS-1,deep symmetrical anterior T wave inversion)and type 2 Wellens' syndrome(WS-2,positive-negative biphasic anterior T waves)according to the electrocardiographic T-wave changes.WS-1 type is more common that accounting for about 75 % and WS-2 type is rare that accounting for about 25%.There is a view that the WS-2 type is more dangerous than WS-1 type,but one study has found no difference in the degree of LAD stenosis,number of cardiac risk factors,etc.Up till the present moment,clinical study about differences between the two types with coronary artery stenosis and clinical risk is few and reach no consensus.This article is to explore the differences between patients with WS-1 and WS-2 in terms of stenoses of left anterior descending artery(LAD),Gensini scores,other characteristics of coronary angiograph(CAG),cardiac functions and risk assessments.Objects and Methods1.Objects of study: clinical data of 582 inpatients who underwent coronary angiography and met the diagnostic criteria of UA and NSTEMI from January 2016 to May 2017 in the Second Affiliated Hospital of Zhengzhou University were retrospectively analysed.A total of 45 cases met the diagnostic criteria of Wellens' syndrome,19 cases are males and 26 cases are females,aged 63.8�11.2 years.There were 33 cases in WS-1 group and 12 cases in WS-2 group.The degree of coronary artery lesions was assessed by Gensini scores according to the results of coronary angiography.The risk assessment of every case was assessed by the Thrombolysis in Myocardial Infarction(TIMI)risk score according to their clinical data.The basic information,laboratory inspections,amplitude of inverted T waves,stenoses of LAD,Gensini scores,other CAG findings,echocardiographic data and TIMI risk scores were compared between the two groups.2.Statistical Methods: SPSS 22.0 software was used for analysis.The normality test was performed on the quantitative data.When the normal distribution was observed,it was expressed as ?x�s and the Independent-Samples T test was adopted for the comparison between the two groups.When the non-normal distribution was observed,it was expressed as M(Q1,Q3)and the Mann-Whitney U test was adopted.Count data are expressed in n(%)and adopted ?2 test or Fisher exact probability test.All statistical tests were two-sided,and P < 0.05 was considered statistically significant.Results1.Plasma NT-proBNP concentration was 148.3(72.9,441.0)pg/ml in WS-2 group and 576.9(208.0,1194.8)pg/ml in WS-2 group,the difference was statistically significant(Z=-2.105,P=0.035).2.The maximal stenoses of LAD in WS-2 group was more severe than that in WS-1 group(Z=-2.044,P=0.041).However,no significant difference was found between the two groups with Gensini score,location of maximal stenoses in LAD and TIMI flow grade of LAD(P>0.05).3.The TIMI risk scores in WS-2 group was significantly higher than in WS-1 group(Z=-2.267,P=0.023).4.The amplitude of T-wave inversion of leads V2 is 0.20(0.20,0.25)mV in WS-2 group and 0.30(0.25,0.47)mV in WS-1 group,the difference was statistically significant(Z=-3.781,P<0.001).The amplitude of T-wave inversion of leads V3,maximum inverted T-wave amplitude and mean amplitude of T-wave inversion in WS-1 group are deeper than in WS-2 group(0.41�0.16 mV vs 0.30�0.10 mV,0.46�0.16 mV vs 0.35�0.07 mV,0.33�0.09 mV vs 0.24�0.04 mV,P<0.05).5.There was no significant difference in left ventricular ejection fraction(LVEF)and wall motion abnormalities between the two groups(P>0.05).Conclusions1.The degree of LAD stenoses in patients with type 2 Wellens' syndrome is more severe than type 1 Wellens' syndrome.2.Patients with type 2 Wellens' syndrome have a higher TIMI risk scores than type 1 Wellens' syndrome.