The Clinical Research On Thr De Winter Electrocardiogram Pattern

Background: The de Winter Electrocardiogram(ECG)pattern was first reported by Dr.De Winter in the New England Journal in 2008.It is a novel sign that indicated left anterior descending coronary artery(LAD)occlusion in patients with the chest pain.It is characterized by an up-sloping ST-segment depression at the J-point in leads V1 to V6 that continues into a tall positive symmetrical T waves.Previous studies have shown that the de Winter ECG pattern was static,and there was no article that described the V3R-V5 R leads and V7-V9 leads with de Winter ECG pattern.The prevalence,clinical characteristics,mechanism and treatment strategies of this particular ECG pattern are not clear.This retrospective analysis aimed to further explore the characteristic changes and clinical characteristics of this kind of ECG pattern for clinic.Method: This retrospective study included all patients with acute anterior myocardial infarction between January 2011 and December 2017 in Yongchuan Hospital of Chongqing Medical University.Patients were divided into two groups: those with the de Winter ECG pattern(study group,n=15)and those with typical ST-segment elevation myocardial infarction(STEMI)(control group,n=426).We analyzed the baseline data,clinical outcomes,electrocardiogram characteristics and treatment strategies of the two groups.Results: Of 441 patients with anterior myocardial infarction,15(3.4%)had the de Winter ECG pattern which was higher than 2%(P=0.042)in the previous De Winter study.Similar to typical STEMI,13 patients with the de Winter ECG pattern had ST-segment elevation or pathologic Q wave or absence of R wave at follow-up,which was different from the previous studies.The median time from recognition of this pattern until evolution was 114 minutes.The ST-segment in leads V3 R to V5 R and leads V7 to V9 were normal or slightly depressed when a typical de Winter ECG pattern was noted in leads V1 to V6.The culprit lesion was mainly in the proximal left anterior descending artery(LAD)or the first diagonal branch.Of these15 patients,four patients received thrombolytic therapy.Two out of four patients under went rescue percutaneous coronary intervention(PCI)following failed thrombolysis,while the other two patients had successful thrombolysis;however,one of the patients experienced re-occlusion afterward.It suggested that patients with this ECG pattern responded poorly to thrombolytic therapy.Compared to patients with typical anterior STEMI(control group),patients in the study group were younger,and had a hypertriglyceridemia,high total cholesterol,and high serum chloride concentration.Conclusion: The de Winter ECG pattern is not static.We believe thatthe de Winter ECG pattern may be a sign of ischemia and presents at the early stage of STEMI.In patients with this pattern,the culprit lesion was mainly in the proximal LAD or the diagonal branch,and a percutaneous coronary intervention need to be performed as soon as possible.