Acute Thrombotic Occlusion of proximal Left Anterior Descending Artery without ST-elevation (de Winter sign) in Electrocardiogram: A Case Report

Introduction: ST-elevation in precordial leads is diagnostic for acute transmural myocardial infarction (MI) related to acute occlusion of left anterior descending artery (LAD). Case presentation: In this case report, a 54-year-old man was admitted to the emergency department (ED) due to chest pain. ST-depression with tall T waves in precordial leads was detected in surface electrocardiogram (ECG). Angiography showed acute total occlusion of proximal LAD and ad hoc percutaneous coronary intervention (PCI) was performed successfully. Conclusion: This case highlights that total occlusion of LAD may present without typical ST-elevation pattern in ECG.