de Winter Pattern (STEMI Equivalent)
Checks a 12-lead tracing for the de Winter pattern, a STEMI equivalent of proximal LAD occlusion without ST elevation.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Upsloping J-point ST depression over 1 mm, precordial
- Yes
- Tall, symmetrical precordial T waves
- Yes
- Contiguous precordial ST elevation
- No
- ST elevation in aVR
- Yes
Result: de Winter pattern present, with ST elevation in aVR: a STEMI equivalent of proximal LAD occlusion under the 2022 ACC decision pathway and the 2025 ACC/AHA guideline.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Upsloping J-point ST depression over 1 mm, precordial
- Tall, symmetrical precordial T waves
- Contiguous precordial ST elevation
- ST elevation in aVR
How this is calculated
Citation
de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA. A new ECG sign of proximal LAD occlusion. N Engl J Med. 2008;359(19):2071-2073. Read the sources: de Winter 2008 ↗, Features and guideline status (2026) ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.