A device (10) that detects and reports the presence of an acute cardiac ischemic condition in a patient includes sensing electrodes (12, 14, 16, 18, 20, 22, 24, 26, 28, and 30) placed on a patient for acquiring multiple (e.g., twelve) lead ECG data from the patient. The device evaluates the acquired ECG data by analyzing global features derived from the ECG data. Global features include projection coefficients calculated from projecting a concatenated vector of representative heartbeat data onto sets of basis vectors that define an acute cardiac ischemic ECG subspace and a non-ischemic ECG subspace. A classifier evaluates the global features to determine whether an acute cardiac ischemic condition is detected. In a further embodiment of the invention, one or more classifiers evaluate local features, such as local morphological features and patient clinical information, in addition to the global features to determine whether an acute cardiac ischemic condition is detected. The device (10) may be configured with an adjustable sensitivity/specificity operating point. The result of the evaluation is reported to the user of the device.