The presence of De Winter electrocardiogram pattern following elective percutaneous coronary intervention in a patient without coronary artery occlusion: A case report

RATIONALE: The De Winter electrocardiogram (ECG) pattern is considered as a ST elevated myocardial infarction (STEMI)-equivalent pattern. Due to its rare nature, it is unclear whether this ECG pattern suggests the presence of some other condition. PATIENT CONCERNS: We reported a 47-year-old man with new-onset chest discomfort several hours after the second-stage percutaneous coronary intervention (PCI). DIAGNOSES: An emergency coronary angiogram (CAG) did not show any abnormality. However, the dynamic changes in the ECG and myocardial biomarkers indicated perioperative myocardial infarction. INTERVENTION: The patient was monitored in the cardiac care unite (CCU), and was administered an intravenous infusion of diltiazem and subcutaneous injection of low molecular weight heparin. OUTCOMES: After a few hours, his symptoms were alleviated. The patient was discharged after 6 days of hospitalization without any complications. LESSONS: The De Winter ECG pattern can be observed in patients without significantly coronary arteries occlusion. The newly onset De Winter ECG pattern after PCI procedure may indicate perioperative myocardial infarction caused by impaired microvascular perfusion.