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Background To explore acute anteriorl ST elevation myocardial infarction with different ST segment changes in inferior leads and the relationship between prognosis and coronary artery lesions.Methods In a retrospective ECG analysis based on the inferior ST segment of electrocardiogram changes, 308 cases of acute anterior-wall myocardial infarction were divided into 2 groups: group A with elevation in at least two leads in Ⅱ,Ⅲ, aVF; group B with depression in at least two leads in Ⅱ, Ⅲ, aVF.A comparison between the 2 groups included CK-MB maximum, left ventricular ejection fraction (LVEF) and infarct-related artery (IRA).