Objective To assess the risk of acute myocardial infarction (AMI) and analyze its out‐come by studying the abnormal ECG presentations in AMI patients .Methods The clinical data and ECG presentations of 381 AMI patients were retrospectively analyzed .The abnrmal ECG presentations and the mortalty were comparatively analyzed in AMI patients with multiple lead pathological Q wave ,elevated ST‐segment ,atrial fibrillation (AF) ,bundle branch conduction block ,cardiogenic shock ,and heart failure .Results T he incidence of cardiogenic shock ,heart fail‐ure and the mortality were significantly higher in patients with multiple lead pathological Q wave than in those without multiple lead pathological Q wave (58 .1% vs 21 .4% ,54 .3% vs 23.2% , 40.0% vs 6 .5% ,P<0 .05) and in patients with abnormal presentations such as elevated ST‐seg‐ment and AF than in those without abnormal ECG presentations (P<0 .05 ,P<0 .01) .Conclusion Abnormal ECG presentations ,such as multiple lead pathological Q wave ,can be used as the evi‐dence for the risk and outcome of AMI .