Clinical characteristics of patients with the de Winter electrocardiogram pattern
Li Liu1, Jie Tian2, Aihua Wang2
1Department of Cardiology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China. 670330086@qq.com.
Insights
The de Winter electrocardiogram pattern in acute coronary syndrome indicates significant left anterior descending artery blockage. This pattern is a critical ST-elevation myocardial infarction equivalent requiring immediate clinical attention.
Area of Science:
- Cardiology
- Electrocardiography
- Acute Coronary Syndromes
Background:
- The de Winter electrocardiogram pattern is an underrecognized sign in acute coronary syndromes.
- It is associated with occlusive disease in the left anterior descending artery.
Purpose of the Study:
- To investigate the electrocardiogram (ECG) manifestations and clinical characteristics of patients presenting with the de Winter ECG pattern.
- To determine the significance of this pattern in acute coronary syndrome (ACS) patients with left anterior descending (LAD) culprit lesions.
Main Methods:
- Retrospective analysis of ACS patients with LAD culprit lesions admitted between August 2017 and October 2018.
- Categorization of patients into those with and without the de Winter ECG pattern.
- Analysis of clinical data and ECG characteristics.
Main Results:
- 14 out of 230 patients (6%) with LAD lesions exhibited the de Winter pattern.
- Patients with the de Winter pattern were younger (53.86±10.26 vs 67.20±11.60 years, P<0.01).
- They also had higher LDL-C, better Killip classification, and shorter onset-to-ECG times compared to controls.
Conclusions:
- The de Winter ECG pattern in patients with acute chest pain suggests subtotal or complete occlusion of the LAD or diagonal branch.
- It is a crucial ST-segment elevation myocardial infarction equivalent.
- Clinicians should pay close attention to this distinctive ECG finding.
Objectives:
To explore the electrocardiogram manifestations and clinical characteristics of patients with the de Winter electrocardiogram pattern.
Methods:
This retrospective study was performed on acute coronary syndrome (ACS), patients with culprit lesion in left anterior descending branch (LAD), who admitted to Yongchuan Hospital of Chongqing Medical University from August 2017 to October 2018. Patients were categorized into those with or without the de Winter electrocardiogram pattern. The characteristics of de Winter electrocardiogram were analyzed by the clinical data of the patients.
Results:
Among 230 patients with left anterior descending branch lesion, 14 (6%) had the de Winter electrocardiogram pattern. Compared with the control group, patients with de Winter electrocardiogram pattern were younger [(53.86±10.26) years old vs (67.20± 11.60) years old P<0.01], at higher LDL-C level [3.54(2.88, 4.20) mmol/L vs 2.61(2.48, 2.73) mmol/L, P=0.01], in lower classification degree of cardiac function [Killip I grade 12 cases (85.71%) vs 95 cases (43.98%), P=0.04], and in shorter time between onset and the first electrocardiogram [171.77(47.56, 295.97) min vs 501.92(405.12, 598.72) min, P=0.01]. Coronary angiography results indicated anterior descending or diagonal branch lesions.
Conclusions:
The de Winter electrocardiogram pattern syndrome in patients with acute chest pain mostly indicates that the left anterior descending or the diagonal branch is subtotal or completely occluded, which is a special ST-segment elevation myocardial infarction equivalent and should attract the clinicians' extensive attention.
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