Aim: To evaluate the use of electrocardiography (ECG) in identifying the culprit artery and localizing the lesion in acute myocardial infarction (AMI) patients. Methods: This was a single-center, prospective study conducted at a tertiary-care center in India. A total of 100 patients diagnosed with AMI who underwent coronary angiography between November 2014 and October 2015 were included in the study. Patients diagnosed with AMI were evaluated, and the ECG findings of each patient were correlated with that of coronary angiogram to localize the culprit vessel involved. Results: A total of 100 patients diagnosed with AMI with a mean age of 55 years were included in the study. Of these, the majority of the patients were male (91%). Out of 100 AMI patients, left anterior descending artery (LAD) was found to be the most common culprit artery [70 (70%) patients] followed by right coronary artery (RCA) [25 (25%) patients] and left circumflex (LCX) artery [5 (5%) patients], respectively. Among this 70% of patients who had LAD as a culprit artery, 10% of patients had additional insignificant lesions in LCX and 5% patients in RCA. Of this 25% of patients who had RCA as a culprit artery, 6% of patients had additional lesions in LAD and 2% patients in the LCX artery.