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ve Aims The optimum definition of ST elevation for diagnosis of acute myocardial infarction, with respect to both the minimum height and the minimum numbers of leads, is unknown. Furthermore, only 50 % of patients with acute myocardial infarction present with ST elevation. We thus quantified the sensitivity and specificity of different ST elevation criteria for diagnosis of acute myocardial infarc-patients. The optimum ST elevation model (based on 1 mm ST elevation in 1 inferior/lateral leads, or 2 mm ST elevation in 1 anteroseptal leads) correctly classified 83·1 % of subjects (55·8 % sensitivity, 94·0 % spe-cificity). The choice of ST elevation definition had marked influence on the sensitivity (45·4–68·6%) and specificity (81·2–98·1%) for diagnosis of acute myocardial infarction