Poor efficacy of intravenous thrombolysis in de Winter pattern: A case report

Abstract

Introduction: Majority of patients with acute coronary syndrome can be quickly identified by electrocardiogram, but there are still 30% of patients with acute coronary artery lesions that cannot be recognized by electrocardiogram in time, resulting in delayed treatment. Patient concerns: Due to its special manifestations, de Winter syndrome is easily ignored by clinicians. Diagnosis: In this article we report a case of de Winter syndrome with poor thrombolytic effect to explore the optimal emergency management strategy for this patient. Interventions: The patient underwent remedial percutaneous coronary intervention (PCI) immediately after diagnosis. Outcomes: Patients recover well after PCI. Conclusion: de Winter syndrome is a strong indication of severe coronary artery disease, requiring rapid identification and opening of coronary vessels to restore blood flow. For patients admitted to hospitals with PCI capacity or transferred primary PCI <2 hours, primary PCI should be performed as soon as possible. Thrombolysis can still be considered for patients first diagnosed in non-PCI institutions with transport time >2 hours, but its efficacy remains to be discussed and further verified.