A 50-year-old man presents with chest pain that has resolved. ECG shows deep biphasic T waves in leads V2 and V3 with isoelectric ST segments. Troponin I is mildly elevated. He is hemodynamically stable. What is the most appropriate next step?
- A Urgent coronary angiography within 24 hours ✓
- B Discharge with outpatient follow-up
- C Exercise stress testing
- D Thrombolytic therapy
Correct answer: A. Urgent coronary angiography within 24 hours
Explanation
Wellens syndrome (Type B: deep biphasic T waves in V2-V3) indicates a critical proximal LAD stenosis and is a pre-infarction equivalent. These patients are at high risk for extensive anterior MI. Urgent coronary angiography with revascularization is required. Stress testing is contraindicated as it may precipitate complete LAD occlusion. Thrombolysis is not indicated as this is not a STEMI pattern. Discharge would be dangerous.
Reference: Braunwald's Heart Disease, 12th ed.
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