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Published on: October 27, 2020
Traces of cardioprotection behind the uncertainty of the de winter pattern
Malekrah Alireza1, Asgary Nader2, Fattahian Alireza1
1Mazandaran University of Medical Science- Department of Cardiology, Sari, Iran.
Insights
The de Winter ECG pattern, similar to STEMI, may be caused by preconditioning, as evidenced by less severe ischemia and better outcomes in affected patients compared to typical STEMI cases. This suggests a protective mechanism in de Winter syndrome.
Area of Science:
- Cardiology
- Electrocardiography
- Ischemic Heart Disease
Background:
- De Winter syndrome presents an electrocardiogram (ECG) pattern equivalent to ST-elevation myocardial infarction (STEMI).
- The underlying mechanisms causing ST depression, rather than ST elevation, in de Winter syndrome remain unclear.
- This study investigates the de Winter pattern by comparing ECG and imaging findings with typical anterior STEMI.
Purpose of the Study:
- To elucidate the mechanisms behind the de Winter ECG pattern.
- To compare electrocardiographic and imaging findings between de Winter pattern patients and anterior STEMI patients.
- To explore potential preconditioning as a cause for the de Winter pattern.
Main Methods:
- A comparative study of 967 patients with anterior myocardial infarction (MI) from January 2019 to December 2022.
- 30 patients with the de Winter pattern were identified and matched with 4 anterior STEMI control patients each.
- Primary percutaneous coronary intervention (PCI) was performed, and patient characteristics were analyzed between the two groups.
Main Results:
- De Winter pattern was observed in approximately 3% of anterior MI patients.
- Multivessel disease was significantly more common in the de Winter group (60% vs. 38%).
- De Winter patients experienced significantly lower rates of malignant arrhythmias (7% vs. 27%) and in-hospital mortality (3% vs. 18%) compared to STEMI patients.
Conclusions:
- The de Winter ECG pattern is associated with less severe ischemia and better clinical outcomes.
- Preconditioning is proposed as a potential underlying mechanism for the de Winter ECG pattern.
- Further research is warranted to confirm the role of preconditioning in de Winter syndrome.
Introduction:
Although de Winter syndrome is equivalent to STEMI, the cause of ST depression rather than ST elevation is still unknown. This study aimed to investigate the mechanisms underlying the de Winter pattern by comparing ECG and imaging findings between patients exhibiting this pattern and those with typical anterior STEMI.
Methods:
This study was conducted from January 2019 to December 2022 on 967 patients diagnosed with anterior MI. 30 patients were diagnosed with the de Winter pattern, and each patient was matched with 4 patients in the anterior STEMI group. Patients underwent primary PCI, and their characteristics were examined in two groups.
Results:
Approximately 3 % of patients with anterior MI showed a de Winter pattern. 67 % of the cases in the de Winter group and 62 % in the control group were male (P-value = 0.6). Multivessel disease was more prevalent in de Winter patients (60 % vs. 38 %; P-value = 0.03). Well-developed collaterals were present in 20 % of de Winter cases and 26 % of AMI (P-value = 0.5). There was no significant difference in the wall motion score index between the two groups(1.9 de Winter vs. 1.97 AMI; P-value = 0.3).Malignant arrhythmias (7 % vs. 27 %; P-value = 0.01) and in-hospital mortality (3 % vs. 18 %; P-value = 0.04) occurred less frequently in de Winter patients.
Conclusion:
Based on the indirect evidence of the more extensive occurrence of non-lethal ischemia in the de Winter group, along with the better outcomes in these patients, we can consider preconditioning as a possible underlying cause of the de Winter ECG pattern.
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