{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:15:42Z","timestamp":1780542942792,"version":"3.54.1"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The de Winter electrocardiogram pattern, recognized as a critical STEMI\u2010equivalent signaling proximal left anterior descending artery occlusion, presents a persistent dilemma in clinical practice: while primary percutaneous coronary intervention remains the definitive treatment, current guidelines offer no clear direction on thrombolysis\u2013a gap particularly consequential in resource\u2010limited settings where timely intervention is often unfeasible. To navigate this uncertainty, this review critically examines the underlying pathophysiology, synthesizes the often conflicting historical evidence, and integrates recent systematic findings with contemporaneous case reports. Historically, evidence supporting thrombolysis has been limited to isolated, inconsistent case reports, leaving clinicians without reliable guidance. A pivotal shift emerges from a 2025 systematic review, which offers the first quantitative synthesis, demonstrating that nearly 80% of patients receiving thrombolysis achieved successful reperfusion\u2013a figure that reframes the risk\u2010benefit calculus. Beyond efficacy, recent case data highlight essential nuances for patient selection; for instance, certain conditions like spontaneous coronary artery dissection can mimic the de Winter pattern but constitute absolute contraindications to thrombolytic therapy, underscoring the necessity for precise diagnostic differentiation. Consequently, in scenarios where primary PCI is delayed beyond 120 min, thrombolysis emerges as a viable and potentially lifesaving bridging strategy for carefully selected patients exhibiting the classic ECG findings. This pharmaco\u2010invasive approach, however, demands rigorous clinical assessment and must be followed by immediate, mandatory transfer to a PCI\u2010capable center to ensure comprehensive care.<\/jats:p>","DOI":"10.1002\/ccd.70501","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T03:59:30Z","timestamp":1770695970000},"page":"1432-1436","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Thrombolysis for De Winter Syndrome When Percutaneous Coronary Intervention is Delayed: A Critical Review"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1804-6819","authenticated-orcid":false,"given":"Bin","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Cardiology Shnzehen Bao'an Chinese Medicine Hospital Shnzehen PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhua","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Bao'an Authentic TCM Therapy Hospital Shenzhen PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2004.91003.x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc0804737"},{"key":"e_1_2_12_4_1","volume-title":"StatPearls","author":"Padr\u00f3n G.","year":"2024"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad191"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.15420\/japsc.2024.43"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.70115"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1415306"},{"key":"e_1_2_12_9_1","first-page":"45","article-title":"The De Winter Electrocardiographic Pattern: A Systematic Review of Case Reports","volume":"87","author":"Alizadeh A.","year":"2024","journal-title":"Journal of Electrocardiology"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx393"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.23002"},{"issue":"6","key":"e_1_2_12_12_1","article-title":"Case Report: De Winter's Pattern, STEMI Equivalents, and Percutaneous Intervention","volume":"16","author":"Alhatemi A. Q.","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcx253"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/6868204"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050313X251331733"},{"issue":"4","key":"e_1_2_12_16_1","article-title":"ST\u2010Elevation Myocardial Infarction: A New Paradigm for an Old Diagnosis","volume":"13","author":"Aslanger E. K.","year":"2024","journal-title":"Journal of the American Heart Association"},{"issue":"8","key":"e_1_2_12_17_1","article-title":"Comparison of the ST\u2010Elevation Myocardial Infarction (STEMI) Criterion and the Occlusion Myocardial Infarction (OMI) Classification of Acute Myocardial Infarction","volume":"14","author":"Meyers H. P.","year":"2022","journal-title":"Cureus"},{"issue":"9","key":"e_1_2_12_18_1","first-page":"614","article-title":"Reperfusion Strategies in Acute Myocardial Infarction: A Focus on Resource\u2010Limited Settings","volume":"20","author":"Gerschutz G. L.","year":"2023","journal-title":"Nature Reviews Cardiology"},{"key":"e_1_2_12_19_1","first-page":"112","article-title":"Fibrinolytic Therapy in De Winter Pattern: A Case Report and State\u2010of\u2010the\u2010Art Review","volume":"86","author":"Wang J.","year":"2024","journal-title":"Journal of Electrocardiology"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70501","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70501","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70501","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T03:46:45Z","timestamp":1775101605000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70501"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/ccd.70501"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70501","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,9]]},"assertion":[{"value":"2025-11-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}