The de Winter electrocardiographic pattern evolves to ST elevation in acute total left main occlusion: A case series

Liu, Chunwei; Zhang, Jingxia; Hu, Yuecheng; Wang, Le; Cong, Hongliang

doi:10.1111/anec.12855

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…1 A). Interestingly, there were three patients (only one survived) who presented with a de Winter ECG pattern, with the two evolving to ST elevation in the precordial leads within hours of presentation before any coronary intervention [ 10 ]. There was no difference in the ECG patterns among the patients stratified by age and symptom onset to first medical contact time ( p > 0.05).…”

Section: Resultsmentioning

confidence: 99%

Electrocardiographic patterns predict the presence of collateral circulation and in-hospital mortality in acute total left main occlusion

Liu

Yang

Zhang

et al. 2022

BMC Cardiovasc Disord

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Background Data on the clinical characteristics, electrocardiogram (ECG) findings and outcomes of patients with acute myocardial infarction (AMI) due to total unprotected left main (ULM) artery occlusion is limited. Methods Between 2009 and 2021, 44 patients with AMI due to total ULM occlusion underwent primary percutaneous coronary intervention (PCI) at our institution. The ECG, collateral circulation, clinical and procedural characteristics, and in-hospital mortality were retrospectively evaluated. Results Twenty five patients presented with shock and 18 patients had in-hospital mortality. Nineteen patients presented with ST-segment elevation myocardial infarction (STEMI), while 25 presented with non-ST-segment elevation myocardial infarction (NSTEMI). ST-segment elevation (STE) in I and STEMI were associated with the absence of collateral circulation, while STE in aVR was associated with its presence. In the NSTEMI group, patients with STE in both aVR and aVL showed more collateral filling of the left anterior descending coronary artery (LAD) territory, while patients with STE in aVR showed more collateral filling of the LAD and the left circumflex artery territory. Compared with total ULM occlusion, patients with partial ULM obstruction presented with more STE in aVR, less STE in aVR and aVL, and less STEMI. Shock, post-PCI TIMI 0–2 flow, non-STE in aVR, STEMI, and STE in I predicted in-hospital mortality. STEMI and the absence of collateral flow were significantly associated with shock. Conclusions STE in the precordial leads predicted the absence of collateral circulation while STE in aVR and STE in both aVR and aVL predicted different collateral filling territories in ULM occlusion. STE in I, non-STE in aVR, and STEMI predicted in-hospital mortality in these patients.

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Section: Resultsmentioning

confidence: 99%

Electrocardiographic patterns predict the presence of collateral circulation and in-hospital mortality in acute total left main occlusion

Liu

Yang

Zhang

et al. 2022

BMC Cardiovasc Disord

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“…(Ghaffari et al, 2021 ) reported a de Winter ECG pattern in which the RCA was complete thrombotic occlusion. (Liu et al, 2022 ) reported a de Winter ECG pattern of acute total left main occlusion. Different from the above, as far as I know, we are the first to report a case of de Winter with multi‐vessel disease.…”

Section: Discussionmentioning

confidence: 99%

“…described a de Winter pattern caused by a large diagonal branch culprit lesion rather than LAD (Ghaffari et al, 2021). reported a de Winter ECG pattern in which the RCA was complete thrombotic occlusion (Liu et al, 2022). reported a de Winter ECG pattern of acute total left main occlusion.…”

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confidence: 99%

The De Winter‐like electrocardiogram pattern associated with multi‐vessel disease

Wang

Yan

Wang

2022

Noninvasive Electrocardiol

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An 81-year-old male patient with hypertension was admitted to our hospital with chest pain for 10 days and aggravation for 2 days. Chest pain occurred several times a week, and each time lasted about 20 min for self-relief, accompanied by chest tightness and palpitation. His heart rate was 104 bpm, his blood pressure was 118/66 mmHg, and his respiratory was 23 breaths/min with normal cardiac and lung examination. Laboratory tests showed troponin I levels 6.13 ng/ml (normal 0-0.09 ng/ml), creatine kinase 353.1 U/L (normal 25-200 U/L), creatine kinase-MB levels 15.34 ng/ml (normal 0-5 ng/ml). The echocardiogram showed regional wall motion abnormalities in inferior and posterior territories. The 12-lead electrocardiogram (ECG) of patients with chest pain showed upsloping ST-segment depression up to 3 mm at the

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Coronary Angiographic Features of de Winter Syndrome: More Than Just Occlusion of the Left Anterior Descending Artery

Tang,

Xu,

Cheng

et al. 2024

Noninvasive Electrocardiol

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BackgroundThe de Winter electrocardiogram (ECG) pattern is a rare presentation of ST‐segment elevation myocardial infarction (STEMI) equivalent. The clinical profile of de Winter syndrome remains to be clarified.MethodsMedical records of 1865 consecutive patients with acute myocardial infarction admitted from November 2018 to July 2023 were screened. Twelve patients (0.6%) with de Winter syndrome were included. STEMI patients whose culprit vessel was the left anterior descending artery (LAD) but without de Winter ECG pattern were selected as controls after 1:2 matching for age and sex.ResultsThe de Winter syndrome patients were all male, aged 49.0 (46.3–52.5) years. The culprit lesion was the proximal LAD in seven patients (58.3%), the middle LAD in three (25%), the left main coronary artery in one (8.3%), and the ramus intermedius artery in the other. All of their culprit lesions had TIMI Thrombus Grade < 4, Cohen‐Rentrop Score ≤ 2, and residual stenosis ≥ 80% after pretreatment with thrombus aspiration or balloon predilatation. Intracoronary imaging data were available in four patients, showing severe atherosclerotic stenosis. Compared with STEMI, de Winter syndrome had a higher prevalence of prior recurrent angina (75.0% vs. 37.5%, p = 0.034), better coronary collateralization (Cohen‐Rentrop Score: 1 vs. 0, p = 0.001), lower thrombus burden (TIMI grade: 1 vs. 2, p = 0.005) but more severe atherosclerotic stenosis in the culprit lesions (90% vs. 60%, p < 0.001).ConclusionsThe culprit lesions of de Winter syndrome have a low thrombus burden, severe atherosclerotic stenosis, and poor collateral circulation protection.

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The de Winter electrocardiographic pattern evolves to ST elevation in acute total left main occlusion: A case series

Cited by 4 publications

References 18 publications

Electrocardiographic patterns predict the presence of collateral circulation and in-hospital mortality in acute total left main occlusion

Electrocardiographic patterns predict the presence of collateral circulation and in-hospital mortality in acute total left main occlusion

The De Winter‐like electrocardiogram pattern associated with multi‐vessel disease

Coronary Angiographic Features of de Winter Syndrome: More Than Just Occlusion of the Left Anterior Descending Artery

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