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Phenomenon of "de Winter" pattern, sign, or syndrome: A systematic scoping review and data analysis

Eman Elmenyar1, Mohammad Adeeb Abbara1, Zeina Al-Ghoul1

  • 1Faculty of Medicine, Bahçeşehir University, Istanbul 34734, Türkiye.

World Journal of Cardiology
|February 16, 2026
PubMed

Insights

The de Winter (dW) pattern, sign, and syndrome are STEMI equivalents. Early recognition and intervention are crucial for patients with this phenomenon, which has unique characteristics.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Electrocardiography

Background:

  • The de Winter (dW) pattern, sign, and syndrome are recognized as ST-elevation myocardial infarction (STEMI) equivalents.
  • These patterns describe specific electrocardiographic findings, with the syndrome also encompassing acute coronary symptoms.
  • Emerging evidence indicates the dW pattern may precede or alternate with STEMI.

Purpose of the Study:

  • To enhance the recognition of the dW pattern, sign, and syndrome.
  • To advocate for early, aggressive treatment strategies.
  • To investigate potential sex-based differences in presentation and outcomes.

Main Methods:

  • A systematic scoping review of literature was performed.
  • Searches were conducted in PubMed/MEDLINE and Google Scholar from November 2008 to June 2025.
  • Data analysis adhered to the PRISMA-Scoping extension guidelines.

Main Results:

  • 322 patients with the dW pattern were identified, predominantly young males with risk factors like smoking, hypertension, and dyslipidemia.
  • The left anterior descending artery (LAD) was the most common culprit vessel (88.5%).
  • Males exhibited a higher rate of severe LAD stenosis compared to females (45.2% vs. 17.7%), and the overall mortality rate was 3%.

Conclusions:

  • The dW phenomenon encompasses distinct demographics, risk factors, pathophysiology, and angiographic features.
  • Interchangeable use of dW pattern, sign, and syndrome highlights the need for standardized recognition.
  • Prompt identification and urgent intervention are critical for managing patients with the dW phenomenon.
Abstract

Keywords:
Acute coronary syndromeDe WinterElectrocardiographic patternST-elevation myocardial infarction equivalentSyndrome

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