Iranian Heart Association Iranian Heart Journal 27 2 2026 04 01 Wellens Syndrome Following Transient ST-Elevation Myocardial Infarction: A Clinical Dilemma of “Treat Now or Later?” 87 93 242143 EN Pandit Bagus Tri Saputra Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 0000-0002-5815-0592 Budi Baktijasa Dharmadjati Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Yosua Hendriko Manurung Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Kevin Luke Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 0000-0003-2160-2927 Journal Article 2025 10 04 <strong><em><span>Introduction:</span></em></strong><span> Transient ST-segment elevation myocardial infarction (TSTEMI) is often associated with better prognosis due to spontaneous reperfusion, yet its progression to Wellens syndrome indicates severe left anterior descending (LAD) occlusion and raises the risk of anterior infarction.</span> <span> </span> <strong><em><span>Case Presentation:</span></em></strong><span> We describe a 61-year-old woman with the initial presentation of typical chest pain (numeric rating scale [NRS]: 6/10) and ST-segment elevation at the extensive anterior leads at the referring hospital. The patient was given dual antiplatelet treatment and referred to our hospital. Upon arrival, her symptoms resolved (NRS: 0/10), and her ST-segment elevation was evolved to biphasic T waves in leads V₂-V₆ along with ST elevation-T-wave inversion in leads I and aVL, similar to Wellens syndrome. Cardiac biomarkers were markedly elevated, and echocardiography revealed hypokinetic wall motion abnormalities. Coronary angiography revealed proximal LAD occlusion, a feature of Wellens syndrome. Despite the potential for extensive myocardial damage, the patient was managed under a delayed invasive strategy. She remained stable after the intervention and at 3 months’ follow-up at the outpatient clinic.</span> <span> </span> <strong><em><span>Conclusions:</span></em></strong><span> Conversion of TSTEMI to Wellens syndrome raises clinical dilemma regarding invasive strategy decision-making. TSTEMI occurs due to spontaneous resolution, which can be partial or total, yet the risk of spontaneous reocclusion is also inevitable. TSTEMI requires an early invasive strategy (< 24 h) with close monitoring of new or worsening ischemic signs; however, the urgency may be individualized on a case-by-case basis. </span><strong><em><span>(Iranian Heart Journal 2026; 27(2): 87-93)</span></em></strong> https://journal.iha.org.ir/article_242143_afd5e47fb62006edfff3e6fd7b719db4.pdf