The de Winter's pattern revisited: a case series.

Area of Science:

• Cardiology
• Emergency Medicine
• Electrocardiography

Background:

• The de Winter ECG pattern, associated with proximal LAD occlusion, was initially believed to be static.
• Previous recommendations favored primary PCI for managing this condition.

Purpose of the Study:

• To investigate the dynamic nature of the de Winter ECG pattern.
• To evaluate management strategies for patients presenting with the de Winter ECG pattern.

Main Methods:

• Presentation and management of two distinct cases with the de Winter ECG pattern.
• Case 1: Initial de Winter pattern progressing to anterior STEMI, treated with emergency PCI.
• Case 2: De Winter pattern managed with a pharmacoinvasive strategy due to PCI time constraints, followed by stenting.

Main Results:

• The de Winter pattern evolved into STEMI in one case, suggesting it is not static.
• Resolution of the de Winter pattern was observed following reperfusion therapy.
• Both cases involved significant Left Anterior Descending (LAD) artery occlusion.

Conclusions:

• The de Winter ECG pattern may represent a dynamic stage of ischaemia, potentially progressing to STEMI.
• Thrombolytic therapy can be considered when timely primary PCI is not feasible.
• Early recognition and intervention for the de Winter pattern are crucial due to its high-risk nature.