Early diagnosis of acute coronary artery occlusion based on electrocardiogram (ECG) findings is essential for prompt delivery of primary percutaneous coronary intervention. Current ST elevation (STE) criteria are specific but insensitive. Consequently, it is likely that many patients are missing out on potentially life-saving treatment. Experts combining non-specific ECG changes with STE detect ischaemia with higher sensitivity, but at the cost of specificity. We show that a deep learning model can detect ischaemia caused by acute coronary artery occlusion with a better balance of sensitivity and specificity than STE criteria, existing computerised analysers or expert cardiologists.