Background: Inferior wall Myocardial Infarction (IWMI) is usually caused by the occlusion of right coronary artery (RCA)or the left circumflex coronary artery (LCX). ECG is widely available method that is routinely applied and used to predict culprit artery in inferior STEMI. Objective: To evaluate clinical significance of ST segment deviation in standard ECG during inferior wall STEMI for prediction of infarct related artery (IRA). Patients and methods: Fifty patients with acute inferior myocardial infarction who were diagnosed based on the presence of history of chest pain of<12 hours with ST segment elevation>1mm in at least 2 or 3 inferior leads & ST segment deviation of other leads with increase in cardiac enzymes All patients were subjected to echocardiography and coronary angiography as the culprit artery was determined from angiographic characteristic of occlusion. Results: In our study, fifty patients with acute inferior myocardial infarction were included. The studyinclude37(74%) males and 13(26%) females with age ranged from 37 to 85 years old with mean age as (55±17) years. According to coronary angiography, RCA was responsible for 34 (68%) patients and LCX was responsible for 16 (32%) patients. Criteria of ECG are useful in prediction of LCX artery inpatients with inferior STEMI were:(I) ST segment elevation inlead III < lead II. (II) ST segment depression in lead avR. (III)ST segment depression in V2, V3. (IV)ST segment elevation in V5, V6. The most useful criteria of ECG for RCA occlusion were ST segment elevation (lead III>II). Conclusion: The conventional ECG criteria based on ST segment deviations in different leads allowed us to predict the location of occlusion with good accuracy.