Key result
The de Winter's ECG pattern may evolve into STEMI, and a pharmacoinvasive strategy with thrombolytic therapy can be considered if primary PCI cannot be offered timeously.
Why the study?
The de Winter electrocardiogram pattern signifying proximal LAD occlusion was thought to represent static ECG changes with primary PCI as the optimal management strategy.
Case Report (n=2)
The de Winter's ECG pattern may evolve into STEMI rather than being static, and a pharmacoinvasive strategy may be considered if primary PCI is delayed.
Answers are grounded in this paper and cite their sources.
May warrant urgent angiography for de Winter pattern; extends case-based evidence of its dynamic progression to STEMI.
Background The de Winter’s electrocardiogram (ECG) pattern signifying proximal left anterior descending (LAD) artery occlusion was first described in 2008. The ECG changes were thought to be static and mechanisms for this were suggested. In addition, the optimal management of these patients was reported to be via a primary percutaneous coronary intervention (PCI) strategy. Case summary Case 1: A 48-year-old gentleman presented with a 2-h history of ischaemic chest pain with initial de Winter’s pattern on ECG. This progressed to anterior ST-elevation myocardial infarction (STEMI) complicated by ventricular fibrillation. Emergency angiography revealed a mid-vessel LAD occlusion which was successfully reperfused. Case 2: A 34-year-old female presented with a 2-h history of ischaemic chest pain with initial ECG showing a de Winter’s pattern. Due to concerns of performing PCI timeously, a pharmacoinvasive strategy of reperfusion was adopted with resolution of the de Winter’s pattern. Urgent angiography revealed a proximal LAD lesion which was successfully stented. Discussion The two cases highlight that the de Winter’s pattern may in fact not be static, but rather lie along the continuum of ischaemia and may evolve into STEMI. In addition, we provide further evidence that if primary PCI cannot be offered in a timeous manner, thrombolytic therapy may be considered in such patients. The de Winter’s pattern remains a high-risk ECG pattern that requires early recognition and intervention.
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John et al. (2020) conducted a case report in de Winter's ECG pattern (n=2). Reperfusion therapy (PCI or thrombolysis) was evaluated. The de Winter's ECG pattern may evolve into STEMI, and a pharmacoinvasive strategy with thrombolytic therapy can be considered if primary PCI cannot be offered timeously.
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