The dynamic evolution of the de Winter ECG pattern that is easily overlooked and life-threatening: a case report and literature review

作者：Yingmei Chen, Bao Chen, Lili Zhang, Wang Liao, Miao Wang · 发表于：Frontiers in Cardiovascular Medicine · 年份：2025 · DOI：10.3389/fcvm.2025.1574829 · 被引用次数：3 · 研究领域：Acute Myocardial Infarction Research、Cardiac Imaging and Diagnostics、ECG Monitoring and Analysis

Background: Rapid diagnosis of patients with acute coronary syndrome (ACS) is crucial for saving their lives. The de Winter electrocardiogram (ECG) pattern is rare and is treated similarly to ST-segment elevation myocardial infarction (STEMI) and acute thrombotic occlusion of the coronary artery. The de Winter ECG pattern has been previously reported, but its dynamic evolution and characteristics have not been summarized. Methods: We reported two male patients who presented with de Winter ECG pattern at rest, and neither patient had a family history of hypertension, diabetes, or coronary heart disease. An urgent examination in our hospital showed elevated levels of cardiac troponin T. Both patients underwent emergency coronary angiography, which revealed subtotal proximal left anterior descending (LAD) stenosis. There was an improvement in chest tightness and pain after stent implantation. Serial ECGs before and after percutaneous coronary intervention showed dynamic evolution of ECG. A literature review was conducted to examine reported coronary angiography findings in patients with the de Winter pattern. The review focused on the dynamic evolution of the ECG and the accuracy of this pattern in diagnosing acute coronary artery occlusion (culprit vessel). It also highlighted the danger of the de Winter ECG pattern and the importance of emergency treatment. Results: Eighteen patients, including two of our patients, presented with the de Winter ECG pattern. Our two cases demons...