The de Winter electrocardiography (ECG) pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain. We report a case of a 34-year-old man with a history of smoking who presented to the local emergency department with a 49 min history of chest pain. The first ECG of the patient indicated that ST-segment elevation was noted in the lead V2–V4; 57 min later, a second ECG revealed a typical de Winter syndrome when the patient was transferred to the emergency chest pain centre of our hospital. A percutaneous coronary intervention (PCI) was performed approximately 8 h later because the patient initially refused the PCI. Acute coronary artery angiography showed that the proximal left anterior descending coronary artery was completely occluded. Our case suggests that ST-segment elevation myocardial infarction may evolve in the direction of de Winter, which reflects a coronary thrombus in formation, so the de Winter ECG pattern should not be considered static.

中文翻译：

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进化的 de Winter 模式：从 STEMI 到 de Winter ECG——病例报告

de Winter 心电图 (ECG) 模式是提示胸痛患者左冠状动脉前降支近端闭塞的标志。我们报告了一例有吸烟史的 34 岁男性，他因胸痛 49 分钟到当地急诊科就诊。患者的第一次心电图显示 V2-V4 导联 ST 段抬高；57分钟后，患者转入我院急诊胸痛中心时，第二次心电图显示典型的德温特综合征。大约 8 小时后进行了经皮冠状动脉介入治疗 (PCI)，因为患者最初拒绝接受 PCI。急性冠状动脉造影显示左冠状动脉前降支近端完全闭塞。