De Winter Sign as an Anterior ST-Segment Elevation Myocardial Infarction Equivalent

de Winter sign is a well-recognized electrocardiographic pattern that represents an acute proximal left anterior descending (LAD) coronary artery occlusion. Despite the absence of a classic ST-segment elevation, it is considered an ST-segment elevation myocardial infarction equivalent and requires emergent reperfusion therapy.

We report the case of an older patient presenting with acute chest pain whose initial electrocardiogram demonstrated de Winter sign. Prompt recognition led to emergent coronary angiography, confirming proximal LAD occlusion, and successful percutaneous coronary intervention. His course was complicated by cardiogenic shock requiring mechanical circulatory support.

This case highlights the importance of early recognition of the de Winter sign, representing acute proximal LAD occlusion despite the absence of an ST-segment elevation, to avoid delays in reperfusion therapy and improve clinical outcomes.