In this study we investigate the effect that ECG electrode placement can have on the detection of ST segment changes. BSPMs from 45 subjects undergoing PTCA were analysed (15 left anterior descending, 15 left circumflex and 15 right coronary artery). 12-lead ECG were extracted from BSPMs corresponding with correct precordial electrode positioning and corresponding with simultaneous vertical movement of all of the precordial leads in 5mm increments up to +/-50mm away from the correct position. A computer algorithm was developed based on current guidelines for the detection of STEMI and Non-STEMI. This algorithm was applied to all of the extracted 12-lead ECGs. Median sensitivity and specificity, based upon all baseline versus all peak balloon inflation cases, were calculated for results generated at each electrode position. With the precordial leads positioned correctly the sensitivity and specificity were 51.1% and 91.1% respectively. When all precordial leads were placed 50mm superior to their correct position the sensitivity increased to 57.8% whilst specificity remained unchanged. At 50mm inferior to the correct position the sensitivity and specificity were 46.7% and 88.9% respectively. The results show a variation of more than 10% in sensitivity when the electrodes are moved up to 100mm vertically.