Clinically-informed modification of the ResNet-18 architecture for identifying occlusion myocardial infarction (OMI) -- a severe, often ST-elevation-negative heart attack caused by complete blockage of a coronary artery -- from a single 12-lead ECG. The network first learns lead-specific temporal features via 1xk temporal convolutions, then learns cross-lead spatial concordance/discordance (e.g. reciprocal ST changes) via a 12x1 spatial convolution placed after the residual blocks, with saliency maps highlighting the most relevant leads and waveform regions for explainability. Benchmarked against ResNet-18 and other CNN/random-forest baselines on a multisite real-world clinical dataset of 10,893 ECGs (OMI rate 6.5%), reaching a test AUROC of 0.889 and an average precision of 0.587, outperforming the compared models.

Open-source, reproducible pipeline for representing 12-lead ECGs as explicit graphs -- nodes per lead-timepatch, with edges encoding established inter-lead spatial relationships (fully-connected limb- and chest-lead subgraphs bridged via leads I, aVF, V4, and V5) -- and classifying them with a Graph Convolutional Network, paired with GNNExplainer to surface which leads and lead-pairs drove each prediction. Evaluated on PTB-XL for five-class diagnostic superclass classification (AUC 0.86) and, with the same architecture, on anteroseptal-vs-inferior myocardial-infarction localization (AUC 0.92), externally validated on the population-based SHIP cohort (AUC 0.87). Explainability analysis showed the GNN's lead attention recovers standard ECG diagnostic criteria (e.g. V1-V3 for anteroseptal MI, II/III/aVF for inferior MI). Developed at University Medical Center Gottingen; code and an example trained checkpoint are released under CC BY-NC 4.0.