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The De Winter ECG pattern

morphology and accuracy for diagnosing acute coronary occlusion

systematic review

Morris, Niall P.; Body, Richard

European Journal of Emergency Medicine: August 2017 - Volume 24 - Issue 4 - p 236–242
doi: 10.1097/MEJ.0000000000000463
REVIEW ARTICLE
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The De Winter ECG pattern has been reported to indicate acute left anterior descending coronary artery occlusion and is often considered to be an ‘ST elevation myocardial infarction (STEMI) equivalent’. We aimed to investigate the morphology of the ‘De Winter ECG pattern’ and evaluate the test characteristics of the De Winter pattern for the diagnosis of acute coronary occlusion. We identified papers through the Medline, EMBASE and COCHRANE databases and screened for bias using QUADAS-2. First, measurements were recorded from every ECG reported in the literature and aggregated. Second, diagnostic accuracy data from eligible cohort studies were extracted. The primary outcome was defined as at least 70% angiographic stenosis of a major epicardial vessel. Thirteen papers reported data relevant to question 1 and three papers reported data relevant to question 2. All ECGs showed maximal up-sloping ST depression in lead V3 with a median amplitude of 0.3 mV (interquartile range: 0.2–4 mV). T-wave height peaked in lead V3 with a median amplitude 0.9 mV (interquartile range: 0.8–1.1 mV). The De Winter pattern had positive predictive values of 95.2% (95% confidence interval: 76.2–99.9%), 100% (69.2–100.0%) and 100% (51.7–100%) in the three respective diagnostic studies. There is limited evidence that the De Winter ECG pattern is a ‘STEMI equivalent’. The available data suggest that the pattern has high positive predictive value for acute occlusion. Further research is required to evaluate specificity and to determine whether rapid revascularization improves mortality.

University of Manchester and Central Manchester NHS Foundation Trust, Manchester, UK

Correspondence to Niall P. Morris, MBChB, Manchester Royal Infirmary Emergency Department, Oxford Road, Manchester M13 9WL, UK Tel: +44 16 1276 4147; fax: +44 16 1701 2800; e-mail: niallmorris@doctors.org

Received October 30, 2016

Accepted March 6, 2017

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