Phenomenon of “de Winter” pattern, sign, or syndrome: A systematic scoping review and data analysis

Table 1 Case series and retrospective studies of de Winter pattern

Ref.	Years	Study characteristics	Comments
de Winter et al[1]	2008	Retrospective; 30/1532 AMI (2%); mean age (52 years); male (94%)	(1) 76% isolated LAD disease; (2) Culprit pLAD, PCI done; (3) Wrap-around LAD (50%); and (4) Static status1: One died (3%)
Verouden et al[2]	2009	Retrospective; 35/1855 PCI of LAD	(1) Wrap-around LAD (57%); and (2) 67% had SVD
Xu et al[9]	2018	Retrospective; 15/449 AMI (3.4%); mean age (60 years); male (87%)	(1) 11/15 underwent PCI, 2 underwent successful thrombolysis, and 2 received conservative therapy; and (2) LAD was the culprit in 9
Shahri et al[6]	2022	Case series; 11 with dW pattern; mean age (56 years); male (54%)	(1) The culprit vessel is LAD; and (2) 5 MVD
de Winter et al[10]	2019	Retrospective; 11/701 AMI (1.6%); mean age (65 years); male 91%	(1) Culprit pLAD or mLAD; and (2) PCI not in a timely fashion; 3 died (27%)
Fuji and Ikari[12]	2024	Retrospective; 2/641 ACS; mean age (69 years); male (100%)	(1) Culprit LAD; and (2) 1 patient received PCI and 1 underwent CABG
Tang et al[13]	2024	Retrospective; 12/1865 AMI; mean age (49 years); male (100%)	(1) The culprit vessel was pLAD in 7 and mLAD in 3, LMCA in 1, and 1 in the ramus intermedius artery; (2) 53% had MVD; (3) 3 developed cardiogenic shock; and (4) The median door-to-balloon time was 94.5 minutes
Alireza et al[11]	2025	Retrospective; 30/967 AMI; mean age (61 years); male (67%)	(1) Culprit pLAD treated with PCI within 90 minutes of arrival (100%); (2) Wrap-around LAD (67%); (3) MVD (60%); and (4) Mortality 3%
Chyu et al[7]	2022	Case series; 4 had STEMI equivalent, 1/4 with dW pattern	Total occlusion of LAD after the first septal branch treated with PCI
Ni[8]	2022	Case series of 10 patients (9 males)	All showed dynamic evolution (the explanation was unclear, as no full text was available) 9 had PCI

¹First electrocardiographic > > pre-procedural electrocardiographic until angiographic findings.

AMI: Acute myocardial infarction; PCI: Percutaneous coronary intervention; LAD: Left anterior descending artery; dW: De Winter; ACS: Acute coronary syndrome; STEMI: ST-elevation myocardial infarction; pLAD: Proximal segment of the left anterior descending; SVD: Single vessel disease; MVD: Multi-vessel disease; mLAD: Mid segment of the left anterior descending; CABG: Coronary artery bypass grafting.

Table 2 Characteristics of de Winter pattern by age

Variables	< 55 years old (55%)	≥ 55 years old (45%)
Positive troponin	55.0%	44.0%
Mortality	1.9%	3.7%
Cardiac arrest	6.8%	4.9%
Severe LAD stenosis	42.7%	44.7%
Severe LCx	4.8%	7.3%
Severe RCA	2.9%	8.5%
Severe LMCA	4.9%	4.8%
Severe: ≥ 70% stenosis

LAD: Left anterior descending artery; LCx: Left circumflex; RCA: Right coronary artery; LMCA: Left main coronary artery.

Table 3 De Winter pattern and cardiac arrest (n = 16)

Ref.	Years	Comment	Outcome
Ghazali et al[4]	2020	Chest pain > > dW pattern followed by cardiac arrest > > STEMI	Survived
Tomcsányi et al[22]	2022	Chest pain > > simultaneous dW pattern and STE > cardiac arrest > > Stenting	Survived
Missaoui et al[45]	2020	Chest pain > > dW pattern with STE aVR > > thrombolytic agent > > > cardiac arrest > > stenting	Survived
John et al[46]	2020	Chest pain > > dW pattern > > STEMI > > cardiac arrest > > PCI	Survived
Fernandez-Vega et al[47]	2017	Cardiac arrest > > dW pattern > > PCI	Survived
Carr et al[48]	2016	Chest pain > > STD > > ECG normalization > > cardiac arrest > > dW pattern > > PCI	Survived
Alhatemi et al[49]	2024	Chest pain > > hyperacute T waves > > cardiac arrest > > dW pattern > > PCI	Survived
Wismiyarso et al[50]	2021	Chest pain > > dW pattern > > cardiac arrest > > ECG normalized after defibrillation > > PCI	Survived
Plane et al[51]	2019	Cardiac arrest > > dW pattern > > CAG and thrombus aspiration	Survived
Shepherd and Furiato[52]	2020	Chest pain > > dW pattern > > cardiac arrest > > PCI	Survived
Liu and Wang[53]	2020	Chest pain > > cardiac arrest > > STEMI > > dW pattern > > PCI	Survived
Rujuta et al[54]	2024	Chest pain > > dW pattern > > cardiac arrest > > Q waves and accelerated idioventricular rhythm > > Cardiogenic shock > > IABP > > PCI	Survived
Wang et al[56]	2022	Chest pain > > cardiac arrest > > dW pattern > > cardiac arrest > > STEMI > > PCI	Survived
Tang et al[13]	2024	2/12 dW pattern patients developed sudden cardiac arrest	Survived
Alireza et al[11]	2025	2/967 (7%) dW pattern > > VF	Not mentioned

dW: De Winter; STEMI: ST-elevation myocardial infarction; STE: ST-elevation; aVR: Augmented vector right; PCI: Percutaneous coronary intervention; STD: ST-segment depression; ECG: Electrocardiographic; CAG: Coronary angiography; IABP: Intra-aortic balloon pump; VF: Ventricular fibrillation.

Table 4 Unique conditions presenting with de Winter pattern

Ref.	Years	Medical condition
García-Izquierdo et al[104]	2018	Myocarditis
Porciuncula et al[105]	2019	Acute stent thrombosis
Chen et al[107]	2020	After elective PCI (asymptomatic and no STEMI-equivalent on arrival)
Molina-Lopez et al[106]	2024	Post aortic stenosis repair
Ando et al[108]	2020	Vasospastic angina
Azdaki et al[44]; Hirase et al[91]	2021; 2020	Spontaneous coronary artery dissection
Dai et al[110]	2021	Kounis syndrome
Al-Assaf et al[5]	2024	Blunt chest trauma
Zhang et al[109]	2022	Type A aortic dissection
Daas et al[111]	2025	Coronary artery ectasia
Li et al[112]	2025	Pheochromocytoma
Wei et al[113]	2022	Stroke-heart syndrome

PCI: Percutaneous coronary intervention; STEMI: ST-elevation myocardial infarction.