Published online Feb 26, 2026. doi: 10.4330/wjc.v18.i2.114561
Revised: October 15, 2025
Accepted: December 18, 2025
Published online: February 26, 2026
Processing time: 139 Days and 13.8 Hours
The de Winter (dW) pattern, sign, and syndrome is an ST-elevation myocardial infarction (STEMI) equivalent. The first two forms describe the electrocardiographic characteristics of this phenomenon, while dW syndrome additionally has symptoms indicative of acute coronary syndrome. Emerging evidence suggests that dW pattern precedes or alternates with STEMI patterns.
To improve the recognition of the dW pattern, dW sign, or dW syndrome, urge early aggressive treatment, and determine whether sex matters, by integrating contemporary knowledge through a systematic scoping review and data analysis.
A comprehensive search was conducted across PubMed/MEDLINE and Google Scholar (November 2008 to June 2025), and literature data were analyzed. This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews checklist.
A total of 322 patients presenting with dW pattern were identified. Most patients were young males. Risk factors were primarily smoking, hypertension, and dyslipidemia. Sixteen cardiac arrest events occurred during hospitalization. The main culprit vessel was the left anterior descending artery (LAD) at 88.5%. Compared with the younger group, older patients had more LAD (84% vs 80%) and right coronary artery involvement (4% vs 1.0%). Left main coronary artery occlusion was more prevalent in the younger group (5.0% vs 2.4%). The frequency of total or near-occlusion of LAD and left main coronary artery was similar in the two age groups. Males showed a higher rate of severe LAD stenosis than females did (45.2% vs 17.7%). dW pattern followed by STEMI was noted in 40 cases, STEMI followed by dW pattern in 8 cases, and simultaneous STEMI and dW pattern in 10 cases. The overall mortality rate was 3%.
dW pattern, dW sign, and dW syndrome are commonly used interchangeably describing the dW phenomenon. Patients presenting with this phenomenon have unique demographics, risk factors, pathophysiology, and angiographic characteristics (i.e., distinct culprit lesions and coronary artery involvement). Early identification with a high index of suspicion is crucial and necessitates urgent intervention.
Core Tip: The three forms of the de Winter (dW) phenomenon (dW pattern, dW sign, or syndrome) are used similarly in contemporary literature. This phenomenon has unique risk factors, pathophysiology, and angiographic characteristics. It should be managed as an indicator of ST-elevation myocardial infarction equivalent that requires urgent intervention. However, it is often underrecognized and therefore requires a high index of suspicion. Age and gender are associated with distinct culprit lesions and coronary artery involvement in this phenomenon. By integrating current evidence, prompt recognition and aggressive reperfusion strategies, such as those used in ST-elevation myocardial infarction protocols, are crucial for improving outcomes in this high-risk presentation.