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Characteristic Wellens syndrome de Winter syndrome Prevalence as a STEMI equivalent, % 18 2 Chest pain Intermittent Present Troponin Slightly elevated or normal Elevated ST segment in precordial leads Slightly elevated Depressed Preferential precordial leads V1–V6 V2–V4 T-wave characteristics Profoundly negative or biphasic and symmetric Positive and symmetric (hyperacute T waves) T-wave morphology Abrupt take-off of the negative T wave from V2 to V4 Ascending limb of the T wave commencing below the isoelectric baseline Precordial R-wave progression Normal Normal Pathologic Q waves No No ST-segment elevation in lead aVR No Yes Angiographic findings Critical narrowing of proximal LAD Occlusion of proximal LAD Evolution of the ECG pattern May evolve into “classic” STEMI within weeks Stable or evolving into “classic” STEMI Note: ECG = electrocardiography, LAD = left anterior descending artery, STEMI = ST-segment elevation myocardial infarction.