Coronary Angiographic Features of de Winter Syndrome: More Than Just Occlusion of the Left Anterior Descending Artery

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2024-11-11 DOI:10.1111/anec.70029

Wenyi Tang, Junwei Xu, Fangyuan Cheng, Tianmin Liu, Zijian Lin, Bairong Chen, Jian Chen, Liyun Luo

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Abstract

Background

The de Winter electrocardiogram (ECG) pattern is a rare presentation of ST-segment elevation myocardial infarction (STEMI) equivalent. The clinical profile of de Winter syndrome remains to be clarified.

Methods

Medical records of 1865 consecutive patients with acute myocardial infarction admitted from November 2018 to July 2023 were screened. Twelve patients (0.6%) with de Winter syndrome were included. STEMI patients whose culprit vessel was the left anterior descending artery (LAD) but without de Winter ECG pattern were selected as controls after 1:2 matching for age and sex.

Results

The de Winter syndrome patients were all male, aged 49.0 (46.3–52.5) years. The culprit lesion was the proximal LAD in seven patients (58.3%), the middle LAD in three (25%), the left main coronary artery in one (8.3%), and the ramus intermedius artery in the other. All of their culprit lesions had TIMI Thrombus Grade < 4, Cohen-Rentrop Score ≤ 2, and residual stenosis ≥ 80% after pretreatment with thrombus aspiration or balloon predilatation. Intracoronary imaging data were available in four patients, showing severe atherosclerotic stenosis. Compared with STEMI, de Winter syndrome had a higher prevalence of prior recurrent angina (75.0% vs. 37.5%, p = 0.034), better coronary collateralization (Cohen-Rentrop Score: 1 vs. 0, p = 0.001), lower thrombus burden (TIMI grade: 1 vs. 2, p = 0.005) but more severe atherosclerotic stenosis in the culprit lesions (90% vs. 60%, p < 0.001).

Conclusions

The culprit lesions of de Winter syndrome have a low thrombus burden, severe atherosclerotic stenosis, and poor collateral circulation protection.

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德温特综合征的冠状动脉造影特征：不仅仅是左前降支动脉闭塞

背景：德温特心电图（ECG）模式是ST段抬高型心肌梗死（STEMI）的一种罕见表现。德温特综合征的临床特征仍有待明确：筛选了2018年11月至2023年7月期间连续收治的1865例急性心肌梗死患者的病历。纳入了12名德温综合征患者（0.6%）。在对年龄和性别进行1:2匹配后，选取罪魁祸首血管为左前降支动脉（LAD）但无德温特心电图模式的STEMI患者作为对照：德温特综合征患者均为男性，年龄为49.0（46.3-52.5）岁。7名患者（58.3%）的罪魁祸首是左冠状动脉近端，3名患者（25%）的罪魁祸首是左冠状动脉中段，1名患者（8.3%）的罪魁祸首是左冠状动脉主干，另一名患者的罪魁祸首是斜中动脉。他们的冠状动脉病变均为 TIMI 血栓分级结论：德温特综合征的病灶血栓负荷低，动脉粥样硬化狭窄严重，侧支循环保护能力差。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.