A 'STEMI equivalent' electrocardiogram (ECG) pattern reflects an acute thrombotic occlusion of a large epicardial coronary artery without ST-segment elevation. These ECG patterns are less known by caregivers. We describe the case of a 56-year-old patient suffering from acute chest pain, presenting in our emergency depart-ment with a ‘de Winter' ECG pattern: an upsloping ST-segment depression with tall symmetrical T waves associ-ated with left anterior descending artery occlusion. The ‘de Winter' ECG pattern, as other ‘STEMI equivalent', must be recognized promptly and treated as soon aspossible with emergent reperfusion by percutaneous coronary intervention.