| Objective:To analyze the case data of two patients with acute coronary syndrome whose electrocardiogram(ECG)manifested De Winter ST-T changes in Department of Cardiovascular Medicine,People’s Hospital of Xiangxi Autonomous Prefecture,and combined with the review of relevant literature,the ECG characteristics,evolution,offender vessels,case physiology and treatment strategies of De Winter ST-T change were discussed,so as to deepen clinicians’ understanding of this ECG pattern and to enable timely recognition and effective treatment.Methods: Two patients with acute coronary syndrome whose ECG manifested De Winter ST-T changes who were hospitalized in the cardiology department of our hospital were collected and retrieved from China Knowledge,Wanfang and Pubmed databases to put into a group of cases that met the inclusion and exclusion criteria of this study,and retrospectively analyzed their clinical characteristics,ECG evolution,offender vessels,and treatment strategies.Methods: In this study,we searched about 970 relevant literature from CNKI,Wanfang and Pumed databases at home and abroad in the past 10 years,95 valid literature were included,and statistics showed that there were 105 patients with acute coronary syndrome who presented with De Winter ST-T changes of ECG(including 2patients in our hospital),among which there were 97 males and 8 females,female: male= 1:12,patients The mean age ranged from 29 to 78 years,53.97 ±13.57 years.85 patients presented with chest pain,16 with chest tightness,4 with other manifestations(subsaphoid pain,upper abdominal discomfort,throat tightness)and 52 with a history of previous smoking(in 30 cases no history of smoking was specified in the literature).The offender vessel was the left anterior descending artery(LAD)in 94 cases(80 in the proximal segment and 14 in the middle segment),whereas the non-left anterior descending branch was present in 11 cases(5 each in the left main and first diagonal branches and 1 in the left gyral branch).The offender vessel was a single-vessel lesion in 64 cases and a single-vessel combined with multiple-vessel lesions in 41 cases.36 patients had an electrocardiogram that evolved into wellens syndrome in 2 cases,ST-segment elevation myocardial infarction(STEMI)in 21 cases,and STEMI evolved into deinfarction in 21 cases.21 cases,12 cases of STEMI evolving into De Winter ST-T changes,and 1 case of wellens syndrome evolving into De Winter ST-T changes.Treatment included 87 cases of coronary stent implantation,8 cases of coronary balloon dilatation + coronary stent implantation,4 cases of coronary balloon dilatation,3 cases of thrombolysis + coronary stent implantation,2 cases of oral medication alone and 1case of coronary artery bypass graft.Results:In this study,about 970 related literatures in the past 11 years were retrieved from CNKI,Wanfang and Pumed databases,and 95 effective literatures were included.Statistics show that there are 106 patients with De Winter ST/T-wave complex in ECG and 2 patients in our hospital,a total of 105 patients,Conclusions:(1)Patients with acute coronary syndrome ECG manifesting as De Winter ST-T changes are rare,but their clinical significance is equivalent to STEMI,and clinicians need to identify and manage them promptly.(2)Patients with De Winter ST-T changes lack characteristic clinical manifestations and have atypical ECG performance,which can be easily misdiagnosed and missed.(3)De Winter ST-T of ECG in patients with acute coronary syndrome is more common in the l left anterior descending artery of the offender vessel,and single vessel lesions are more common.(4)The part of De Winter ST-T changes of ECG can evolve,and It is more likely to evolve into a STEMI ECG.(5)Patients with De Winter ST-T changes are more likely to be treated with PCI. |
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