Background: Cardiogoniometry (CGM) is a novel electrocardiac method utilizing computer-assisted threedimensional information on cardiac potentials. Objectives: To study the efficacy of CGM in diagnosing non-ST elevation acute coronary syndrome (NSTE-ACS) and comparing its sensitivity, specificity and accuracy against high sensitive troponin test and a 12-lead ECG performed on admission. Methods: A cohort of 100 patients (mean age 57 years, 37 % female) who presented with acute chest pain without STsegment elevation and were scheduled for coronary angiography within 72 h of admission. Pre-angiographic screening by CGM, high sensitive troponin test and 12-lead ECG were compared with the final diagnosis of NSTE-ACS or relevant significant coronary stenosis(≥70 % stenosis). Results: NSTE-ACS was finally confirmed in 87 cases, whereas the remaining 13 cases without proof of NSTE-ACS served as a control group. Diagnostic sensitivity of CGM for NSTE-ACS was found to be 74 % and its specificity was estimated to be 61 % with an overall accuracy of approximately 66%.The sensitivity of CGM to detect NSTE-ACS or relevant stenosiswas higher than the other diagnostic tools used in this study, even in patients with normal high sensitive troponin and normal ECG. Conclusion: CGM can detect NSTE-ACS at first medical contact. CGM in conjunction with 12-lead ECG and high sensitive troponin may offer a very good tool for early and accurate diagnosis of NSTE-ACS.