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.