Systematic Review of the Clinical Features of de Winter Syndrome and the Role of Thrombolytic Therapy in Resource-limited Settings

Background: Prompt revascularisation of patients presenting with ST-elevation MI (STEMI)-equivalent ECG findings is essential for reducing cardiovascular mortality. Recent studies have highlighted the under-recognition of de Winter syndrome and have stressed the importance of urgent reperfusion. The clinical features of these patients, along with the role of systemic thrombolysis in the absence of percutaneous coronary intervention for early reperfusion, remain unclear. Aim: This study aimed to conduct a systematic review to comprehensively summarise the clinical characteristics of patients with de Winter syndrome and assess the role of systemic thrombolytic therapy in enhancing cardiovascular outcomes when percutaneous coronary intervention is unavailable. Methods: Electronic databases, including PubMed, Google Scholar, Embase and Scopus, were searched for published data on de Winter syndrome, with no restrictions, until July 2024. Descriptive statistics were used for data analysis. Results: In total, 131 studies were included to evaluate the clinical characteristics of patients with de Winter syndrome. The de Winter syndrome patients were predominantly men, with a mean age of 53 years. A history of smoking was the most commonly associated cardiovascular risk factor. The left anterior descending artery was the most frequently involved vessel, followed by multivessel coronary disease. The incidence rate of malignant ventricular arrhythmia was 9%, with a 3% mortality rate. Nearly 80% of patients who received systemic thrombolysis showed a degree of successful reperfusion. Conclusion: This review provides an in-depth summary of the clinical features of de Winter syndrome, and proposes a crucial hypothesis regarding the potential benefits of systemic thrombolytic therapy for prompt reperfusion in the absence of percutaneous coronary intervention.