Intracoronary OCT findings and outcomes in Wellens’ syndrome: a case–control study

Eduardo I. Arteaga-Chan, Department of Interventional Cardiology, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico
Ramón Espinosa-Soto, Department of Interventional Cardiology, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico
Carlos A. Castro-García, Department of Interventional Cardiology, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico
Juan M. Gutiérrez-López, Department of Interventional Cardiology, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico
Andrés Aguilar-Silva, Department of Interventional Cardiology, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico
Rafael A. Sandoval-Espadas, Department of Interventional Cardiology, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico
Fernando Huerta-Liceaga, Department of Interventional Cardiology, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico

Objective: To characterize coronary plaque features using optical coherence tomography (OCT) in patients with Wellens syndrome, compared to patients with acute coronary syndrome without Wellens criteria. Methods: A case–control study was conducted at a tertiary center, including patients with non-ST elevation acute coronary syndrome (NSTE-ACS). OCT findings and cardiovascular events at 9-month follow-up were compared between groups. Subgroup analysis was performed for: (a) Wellens type A (biphasic T-waves) versus type B (deep symmetric inversions) and (b) left anterior descending (LAD) plaque location (proximal, mid, and distal). Receiver operating characteristic (ROC) curves were generated to evaluate the discriminatory power of OCT parameters for identifying Wellens syndrome. Results: A total of 53 patients with NSTE-ACS and culprit LAD lesions, 13 with Wellens syndrome were compared to 40 controls. OCT identified distinct features in Wellens patients, including higher prevalence of macrophage infiltration, thin-cap fibroatheroma (TCFA), large lipid arc > 180°, and smaller minimum lumen area (MLA). Red thrombus and plaque rupture were also more frequent in the Wellens group. No significant differences in 9-month clinical outcomes were observed. ROC analysis identified a lipid arc > 180°, presence of TCFA, and MLA ≤ 1.4 mm2 as the OCT parameters with the highest discriminatory value for Wellens syndrome. Conclusions: OCT imaging revealed distinct plaque characteristics in Wellens syndrome, including larger lipid arcs, TCFA, and smaller MLA. Despite these high-risk features, short-term clinical outcomes were comparable to non-Wellens NSTE-ACS patients.

Keywords: Wellens syndrome. Optical coherence tomography. Vulnerable plaque. Ischemic heart disease.