Date Published

January 19, 2022

Updated For

ALS PCS Version ALS PCS Version 5.2


Would the presence of De Winter T waves be enough to transport the patient to the cath lab. I know its considered a STEMI equivalent but there is no actual ST elevation.


In order to meet the criteria for the STEMI bypass, the 12-Lead ECG criteria of ST elevation must be met. De Winter T waves (up-sloping ST depression, along with peaked T-waves in the precordial leads) can signify a proximal LAD lesion. Similar to a recent Ask MAC question about hyperacute T-waves (another STEMI equivalent) (here), these patients should be transported to the closest emergency department. However, please ensure your ECG findings are communicated to the receiving facility. This ECG finding coupled with the patients presentation may prompt an expedient cath lab referral after they have been assessed in the emergency department.



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