An acute ischemia detection device comprises a 12-lead electrocardiograph (ECG) device (12), an electronic data processing device (12), and a display component (22). The electronic data processing device applies 12-lead ECG to vessel-specific lead (VSL) transforms (50) to 12-lead ECG data acquired by the 12-lead ECG device to generate VSL lead data (e.g., LAD, LCX, and RCA vessel-specific lead data), determines ST values for the VSL lead data, and decides whether the 12-lead ECG data acquired by the 12-lead ECG device indicates acute ischemia by comparing the ST values for the VSL lead data with VSL lead ST thresholds (60). The display component may display an acute ischemia alarm or warning if the decision is the 12-lead ECG data acquired by the 12-lead ECG device indicates acute ischemia, and/or may display the generated VSL lead ECG traces.