Traces of cardioprotection behind the uncertainty of the de winter pattern

Introduction

Although de Winter syndrome is equivalent to STEMI, the cause of ST depression rather than ST elevation is still unknown. This study aimed to investigate the mechanisms underlying the de Winter pattern by comparing ECG and imaging findings between patients exhibiting this pattern and those with typical anterior STEMI.

Methods

This study was conducted from January 2019 to December 2022 on 967 patients diagnosed with anterior MI. 30 patients were diagnosed with the de Winter pattern, and each patient was matched with 4 patients in the anterior STEMI group. Patients underwent primary PCI, and their characteristics were examined in two groups.

Results

Approximately 3 % of patients with anterior MI showed a de Winter pattern. 67 % of the cases in the de Winter group and 62 % in the control group were male (P-value = 0.6). Multivessel disease was more prevalent in de Winter patients (60 % vs. 38 %; P-value = 0.03). Well-developed collaterals were present in 20 % of de Winter cases and 26 % of AMI (P-value = 0.5). There was no significant difference in the wall motion score index between the two groups(1.9 de Winter vs. 1.97 AMI; P-value = 0.3).Malignant arrhythmias (7 % vs. 27 %; P-value = 0.01) and in-hospital mortality (3 % vs. 18 %; P-value = 0.04) occurred less frequently in de Winter patients.

Conclusion

Based on the indirect evidence of the more extensive occurrence of non-lethal ischemia in the de Winter group, along with the better outcomes in these patients, we can consider preconditioning as a possible underlying cause of the de Winter ECG pattern.