Introduction. Rapid diagnosis of acute myocardial infarction is essential for proper treatment and reduction of patient mortality. Electrocardiography plays an important role in its diagnosis. Acute myocardial infarction with ST segment elevation requires urgent reperfusion therapy, that is, primary percutaneous coronary revascularization. A small number of patients with acute myocardial infarction have ST segment depression in one or more leads, whereas ST segment elevation in augmented vector right the electrocardiogram is characteristic for a myocardial infarction without ST elevation, but the clinical course and the severity of disease correspond to the anterior myocardial infarction with ST segment elevation. De Winter T-wave electrocardiography. One of these forms is known as de Winter T-wave pattern, characterized by ST segment depression at the J-point (> 1 mm) in the precordial leads, the absence of ST segment elevation in the precordial leads, high peaked and symmetrical T-waves in the precordial leads and, in most cases, mild ST segment elevation (0.5 mm to 1 mm) in the augmented vector right. These patients have occlusion of the left main coronary artery, occlusion of the proximal segment of the anterior descending artery, or a severe multivessel coronary disease. Patients with this electrocardiographic pattern, which is equivalent to acute myocardial infarction with ST segment elevation, require consideration of emergency reperfusion therapy due to high mortality, compared to other patients with acute myocardial infarction without ST elevation. Primary percutaneous intervention is recommended, or if there is no catheterization laboratory nearby, fibrinolytic therapy may be considered. Because of the lack of clear recommendations, treatment decisions are made individually, from case to case. Conclusion. We need large prospective studies with this specific electrocardiographic pattern to provide quick recognition and proper treatment of the anterior myocardial infarction with ST elevation.