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In this study we present a vectorcardiographic method to identify the culprit artery in acute coronary syndrome (ACS) in a study population of 860 patients with single vessel disease who underwent percutaneous coronary intervention (PCI). This method takes, in addition to the classical STEMI definition of J point elevation >; 100 μV, also features of the QRS complex and the T wave into account. Comparing this method with published algorithms we found, in our data set, an improvement in specificity and sensitivity using QRS axis elevation, QRS-T angle and T axis azimuth in the transverse plane. Extending this method to the ever increasing amount of patients with non-STEMI ACS who underwent PCI, we also found a beneficial effect of inclusion of QRS and T-wave feature on sensitivity and specificity.