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

Area of Science:

• Cardiology
• Internal Medicine
• Emergency Medicine

Background:

• The de Winter electrocardiogram (ECG) pattern is a rare but critical indicator of ST-segment elevation myocardial infarction (STEMI) equivalent.
• The specific clinical and angiographic profile of de Winter syndrome requires further elucidation.

Purpose of the Study:

• To clarify the clinical characteristics and angiographic findings associated with de Winter syndrome.
• To compare the features of de Winter syndrome with traditional STEMI patients.

Main Methods:

• A retrospective analysis of 1865 acute myocardial infarction patients admitted between November 2018 and July 2023.
• Inclusion of 12 patients diagnosed with de Winter syndrome (0.6% of cases).
• Matching of de Winter syndrome patients with STEMI patients (culprit vessel: left anterior descending artery) for age and sex.

Main Results:

• De Winter syndrome predominantly affected males, with a mean age of 49.0 years.
• Culprit lesions were mainly in the proximal left anterior descending artery (LAD), characterized by severe atherosclerotic stenosis (≥80%) and low thrombus burden (TIMI Thrombus Grade < 4).
• Patients with de Winter syndrome exhibited a higher prevalence of prior angina, better coronary collateralization, and more severe culprit lesion stenosis compared to STEMI controls.

Conclusions:

• De Winter syndrome is associated with culprit lesions demonstrating low thrombus burden and severe atherosclerotic stenosis.
• Poor collateral circulation protection is a notable feature in de Winter syndrome.
• Understanding these distinct features is crucial for accurate diagnosis and management of this STEMI equivalent.