Diagnostic Accuracy of Wellens’ Syndrome in Predicting Significant Proximal Left Anterior Descending Artery Stenosis among Patients with Acute Coronary Syndrome

Abstract

Objectives: This study aimed to determine the prevalence and diagnostic accuracy of Wellens’ Syndrome in predicting significant proximal left anterior descending (LAD) artery stenosis among patients presenting with acute coronary syndrome (ACS), using coronary angiography as the gold standard. Methodology: A prospective diagnostic accuracy study was conducted at the Department of Cardiology, CPEIC, Multan, over a six-month period. A total of 356 patients aged 18–60 years with unstable angina or NSTEMI were enrolled consecutively. After baseline assessment, each patient underwent a 12-lead ECG for identification of Wellens’ Syndrome and coronary angiography for definitive evaluation of proximal LAD stenosis. Diagnostic indices including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Subgroup analyses were performed across demographic and clinical strata. Results: The mean age of participants was 44.24 ± 11.08 years, with 54.5% males. Wellens’ Syndrome was identified in 12.9% of the cohort, whereas significant proximal LAD stenosis was present in 25.8%. The syndrome demonstrated high specificity (93.9%) and good NPV (80.0%), but modest sensitivity (32.6%). PPV was 65.2%, and overall diagnostic accuracy was 78.1%. Subgroup analyses revealed consistent specificity across all groups, with sensitivity varying by age, gender, and comorbidities. Conclusion: Wellens’ Syndrome is a relatively prevalent ECG finding in ACS and demonstrates high specificity for detecting significant proximal LAD stenosis. Although its sensitivity is limited, the presence of this ECG pattern strongly suggests critical LAD involvement and supports early invasive evaluation.