Objective: This study was conducted to evaluate the electocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction. Patients and methods: this study involved 50 patients presenting with acute anterior myocardial infarction with st segment elevation >2 mm in two consecutive leads (v1-v3). All patients underwent through history taking, full clinical examination, laboratory work up involving cardiac markers, serial ECGs and coronary angiography within 8 days. ECG changes were correlated with the angiographic site of LAD occlusion whether proximal to 1st diagonal of distal to 1st diagonal. Results: the culprit lesion was proximal to 1st diagonalin 27 (54%) patients, distal to 1st diagonal in 21(42%) patients, and both proximal and distal to 1st diagonal in 2 patients who were excluded from the study. ECG predictors of LAD occlusion proximal to D1 were ST elevation in V1>2.5mm. While ECG predictors of LAD occlusion distal to D1 were absence of ST depression in inferior leads. ST depression avl Q in V4-V5.