{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:25:03Z","timestamp":1787030703264,"version":"build-2736575974"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The de Winter electrocardiograph (ECG) pattern is a well-established ST-elevation myocardial infarction (STEMI) equivalent, most commonly associated with acute occlusion of the proximal left anterior descending (LAD) artery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 54-year-old man presented to the emergency department with two hours of chest pain, sweating, and nausea. The 12-lead ECG showed upsloping J-point depression in leads V2\u2013V6 and lead I, with tall, symmetrical T waves in leads V2\u2013V5, ST-segment elevation in lead aVR, and ST-segment depression in the inferior leads, consistent with the de Winter pattern. Emergency coronary angiography revealed total occlusion of the left main coronary artery (LMCA), and a drug-eluting stent was implanted. Due to refractory heart failure and worsening hemodynamics, the patient underwent intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) treatment. The patient was discharged 40 days later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates that the de Winter ECG pattern may occasionally indicate LMCA occlusion rather than isolated LAD occlusion. In the setting of a de Winter ECG pattern accompanied by inferior lead ST-segment depression and ST-segment elevation in lead aVR, clinicians should raise clinical suspicion for LMCA occlusion\u2014particularly in hemodynamically unstable patients\u2014to facilitate timely and comprehensive intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1865719","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:27:55Z","timestamp":1787027275000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: De Winter electrocardiographic pattern associated with acute total left main coronary artery occlusion"],"prefix":"10.3389","volume":"13","author":[{"given":"Jian","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology, Shandong Medical and Pharmaceutical University Hospital","place":["Binzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiran","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shandong Medical and Pharmaceutical University Hospital","place":["Binzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faming","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shandong Medical and Pharmaceutical University Hospital","place":["Binzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shandong Medical and Pharmaceutical University Hospital","place":["Binzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shandong Medical and Pharmaceutical University Hospital","place":["Binzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.1056\/NEJMc0804737","article-title":"A new ECG sign of proximal LAD occlusion","volume":"359","author":"De Winter","year":"2008","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1097\/MEJ.0000000000000463","article-title":"The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review","volume":"24","author":"Morris","year":"2017","journal-title":"Eur J Emerg Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.4103\/HEARTVIEWS.HEARTVIEWS_4_19","article-title":"De Winter sign in inferior leads: a rare presentation","volume":"20","author":"Karna","year":"2019","journal-title":"Heart 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ST segment elevation in lead aVR with less ST segment elevation in lead V(1)","volume":"38","author":"Yamaji","year":"2001","journal-title":"J Am Coll Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/j.jelectrocard.2012.12.016","article-title":"Diffuse ST depression with ST elevation in aVR: is this pattern specific for global ischemia due to left main coronary artery disease","volume":"46","author":"Knotts","year":"2013","journal-title":"J Electrocardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1865719\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:00Z","timestamp":1787027280000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1865719\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":13,"alternative-id":["10.3389\/fcvm.2026.1865719"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1865719","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1865719"}}