{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:46:41Z","timestamp":1793317601446,"version":"4.5.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Wellens syndrome is a high-risk electrocardiographic pattern associated with significant left anterior descending (LAD) coronary artery disease. Although Pattern A (biphasic T waves) and Pattern B (deep symmetric T-wave inversion) are recognized, their temporal relationship remains incompletely defined. We aimed to describe the clinical, electrocardiographic, echocardiographic, and angiographic characteristics of patients with spontaneous in-hospital evolution from Pattern A to Pattern B.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This retrospective single-centre study included 51 consecutive patients with Wellens syndrome and angiographic confirmation of significant LAD disease (\u226570% stenosis). Serial electrocardiogram (ECGs) obtained during the first 24 h were reviewed by two cardiologists blinded to angiographic findings. Eighteen patients (35.3%) had documented evolution from Pattern A to Pattern B before angiography. Fourteen cases occurred within 6 h of admission and four between 6 and 24 h; all were documented during pain-free intervals. The median left ventricular ejection fraction was 53% (Interquartile Range [IQR], 46\u201360), and high-sensitivity cardiac troponin was elevated in 12 patients (66.7%). Left anterior descending disease was confirmed in all patients, with isolated LAD involvement in 10 and multivessel disease in eight. Revascularization was performed in 13 patients [10 by percutaneous coronary intervention (PCI) and three by coronary artery bypass grafting]. All PCI procedures achieved Thrombolysis in Myocardial Infarction (TIMI) 3 flow. No in-hospital deaths or major adverse cardiovascular events occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuag102","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:54:20Z","timestamp":1784807660000},"page":"778-783","source":"Crossref","is-referenced-by-count":0,"title":["Beyond A and B: exploring a novel dynamic electrocardiogram change in Wellens syndrome"],"prefix":"10.1093","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8289-2019","authenticated-orcid":false,"given":"Edwin A","family":"Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Cardiovascular Intensive Care Unit at Jos\u00e9 de San Mart\u00edn Hospital, Faculty of Medical Sciences, University of Buenos Aires , C\u00f3rdoba Avenue 2351, Buenos Aires 1120 ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Espinosa de la Ossa","sequence":"additional","affiliation":[{"name":"Cardiovascular Intensive Care Unit at Jos\u00e9 de San Mart\u00edn Hospital, Faculty of Medical Sciences, University of Buenos Aires , C\u00f3rdoba Avenue 2351, Buenos Aires 1120 ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6161-436X","authenticated-orcid":false,"given":"Alvaro F","family":"Vargas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Memorial Cardiac and Vascular Institute , Hollywood, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2009-1478","authenticated-orcid":false,"given":"Jos\u00e9 M","family":"Aladio","sequence":"additional","affiliation":[{"name":"Cardiovascular Intensive Care Unit at Jos\u00e9 de San Mart\u00edn Hospital, Faculty of Medical Sciences, University of Buenos Aires , C\u00f3rdoba Avenue 2351, Buenos Aires 1120 ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8632-1475","authenticated-orcid":false,"given":"Diego","family":"Costa","sequence":"additional","affiliation":[{"name":"Cardiovascular Intensive Care Unit at Jos\u00e9 de San Mart\u00edn Hospital, Faculty of Medical Sciences, University of Buenos Aires , C\u00f3rdoba Avenue 2351, Buenos Aires 1120 ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra P","family":"Swieszkowski","sequence":"additional","affiliation":[{"name":"Cardiovascular Intensive Care Unit at Jos\u00e9 de San Mart\u00edn Hospital, Faculty of Medical Sciences, University of Buenos Aires , C\u00f3rdoba Avenue 2351, Buenos Aires 1120 ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"2026102908174482200_zuag102-B1","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/0002-8703(82)90480-X","article-title":"Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction","volume":"103","author":"de Zwaan","year":"1982","journal-title":"Am Heart J"},{"key":"2026102908174482200_zuag102-B2","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12872-022-02560-6","article-title":"Wellens\u2019 syndrome: incidence, characteristics, and long-term clinical outcomes","volume":"22","author":"Zhou","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"2026102908174482200_zuag102-B3","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/0002-8703(89)90742-4","article-title":"Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery","volume":"117","author":"de Zwaan","year":"1989","journal-title":"Am Heart J"},{"key":"2026102908174482200_zuag102-B4","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12872-024-03752-y","article-title":"Wellens syndrome: prevalence, risk factors and coronary angiographic variation. A cross-sectional study","volume":"24","author":"Mohamed","year":"2024","journal-title":"BMC Cardiovasc Disord"},{"key":"2026102908174482200_zuag102-B5","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/9781118392041","volume-title":"Clinical Electrocardiography","author":"Bay\u00e9s de Luna","year":"2012"},{"key":"2026102908174482200_zuag102-B6","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.jaccas.2019.10.030","article-title":"Electrocardiographic diagnosis of life-threatening STEMI equivalents: when every minute counts","volume":"1","author":"Asatryan","year":"2019","journal-title":"JACC Case Rep"},{"key":"2026102908174482200_zuag102-B7","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.annemergmed.2024.11.019","article-title":"ECG patterns of occlusion myocardial infarction: a narrative review","volume":"85","author":"Ricci","year":"2025","journal-title":"Ann Emerg Med"},{"key":"2026102908174482200_zuag102-B8","first-page":"94","article-title":"Wellens syndrome progressing from a very subtle type A to a classic type B Wellens pattern","volume":"58","author":"Arisha","year":"2024","journal-title":"Cardiovasc Revasc Med"},{"key":"2026102908174482200_zuag102-B9","doi-asserted-by":"crossref","first-page":"102094","DOI":"10.1016\/j.jaccas.2023.102094","article-title":"Progression from Patterns A to B in Wellens Syndrome: electrocardiographic progression in Wellens syndrome","volume":"28","author":"Rodr\u00edguez","year":"2023","journal-title":"JACC Case Rep"},{"key":"2026102908174482200_zuag102-B10","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1136\/bmj.38985.646481.55","article-title":"Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)","volume":"333","author":"Fox","year":"2006","journal-title":"BMJ"},{"key":"2026102908174482200_zuag102-B11","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2026102908174482200_zuag102-B12","first-page":"341","article-title":"Timing of invasive strategy in non-ST-elevation acute coronary syndrome: a Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC) of the ESC","volume":"10","author":"Collet","year":"2021","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026102908174482200_zuag102-B13","first-page":"100915","article-title":"Comparison of the ST-elevation myocardial infarction (STEMI) vs. occlusive myocardial infarction (OMI) diagnostic paradigms of acute myocardial infarction","volume":"37","author":"Meyers","year":"2021","journal-title":"Int J Cardiol Heart Vasc."},{"key":"2026102908174482200_zuag102-B14","first-page":"674","article-title":"Time to retire the STEMI\/NSTEMI paradigm and adopt the OMI\/NOMI framework for acute myocardial infarction","volume":"25","author":"Aslanger","year":"2021","journal-title":"Anatol J Cardiol"},{"key":"2026102908174482200_zuag102-B15","first-page":"100634","article-title":"Diagnostic accuracy of the electrocardiogram for acute coronary occlusion: the DIFOCCULT trial","volume":"30","author":"Aslanger","year":"2020","journal-title":"Int J Cardiol Heart Vasc"}],"container-title":["European Heart Journal: Acute Cardiovascular Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjacc\/advance-article-pdf\/doi\/10.1093\/ehjacc\/zuag102\/69941701\/zuag102.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjacc\/article-pdf\/15\/10\/778\/69941701\/zuag102.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjacc\/article-pdf\/15\/10\/778\/69941701\/zuag102.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T12:17:52Z","timestamp":1793276272000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjacc\/article\/15\/10\/778\/8741306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":15,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,7,25]]},"published-print":{"date-parts":[[2026,10,29]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjacc\/zuag102","relation":{},"ISSN":["2048-8726","2048-8734"],"issn-type":[{"value":"2048-8726","type":"print"},{"value":"2048-8734","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,7,25]]}}}