de Winter electrocardiogram pattern evolving into Wellens electrocardiogram pattern in post-percutaneous coronary intervention therapy: a case report

The de Winter electrocardiogram (ECG) pattern and Wellens ECG pattern are rare but critical ECG findings, often considered high-risk equivalents of ST-segment elevation myocardial infarction (STEMI) associated with proximal left anterior descending coronary artery (LAD) occlusion, necessitating urgent angiography and reperfusion. Limited literature documents cases where the de Winter ECG pattern transitions into the Wellens pattern following percutaneous coronary intervention (PCI).

A 73-year-old man with a history of intermittent chest pain over 1 year presented with exacerbation lasting 3 h, leading to hospitalization for acute coronary syndrome (ACS). During chest pain, the ECG displayed the de Winter ECG pattern, prompting immediate emergency coronary angiography. Angiography revealed 90% stenosis at the proximal LAD, subsequently treated with drug-eluting stent placement. The stent expanded well, and LAD forward blood flow was at thrombolysis in myocardial infarction Level 3. Within 24 h post-PCI, the ECG evolved into Type B Wellens pattern, accompanied by the resolution of chest pain. The patient was discharged on the seventh day post-admission.

The de Winter ECG pattern signifies transient severe coronary stenosis during episodes of chest pain. In contrast, the Wellens ECG pattern typically occurs before PCI, with its T-wave changes often appearing during pain-free intervals, indicating spontaneous coronary artery revascularization. Post-PCI, Wellens ECG changes may suggest reperfusion injury. Timely and repeated ECG monitoring in ACS patients is crucial for identifying high-risk ECG patterns and initiating urgent reperfusion therapy. However, a Wellens ECG pattern in pre-cordial leads does not invariably signify LAD occlusion or severe stenosis.