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Morris NP, Body R. The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review. Eur J Emerg Med. 2017;24(4):236-242doi: 10.1097/MEJ.0000000000000463.
Morris, N. P., & Body, R. (2017). The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review. European journal of emergency medicine : official journal of the European Society for Emergency Medicine, 24(4), 236-242. https://doi.org/10.1097/MEJ.0000000000000463
Morris, Niall P, and Body, Richard. "The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review." European journal of emergency medicine : official journal of the European Society for Emergency Medicine vol. 24,4 (2017): 236-242. doi: https://doi.org/10.1097/MEJ.0000000000000463
Morris NP, Body R. The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review. Eur J Emerg Med. 2017 Aug;24(4):236-242. doi: 10.1097/MEJ.0000000000000463. PMID: 28362646.
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Eur J Emerg Med. 2017 Aug;24(4):236-242. doi: 10.1097/MEJ.0000000000000463.

The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review.

European journal of emergency medicine : official journal of the European Society for Emergency Medicine

Niall P Morris, Richard Body

Affiliations

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

PMID: 28362646 DOI: 10.1097/MEJ.0000000000000463

Abstract

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.

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