Introduction: Tombstoning ST- segment elevation is a type of ST-segment elevation with a specific morphology which is observed in the early period of acute myocardial infarction (AMI). We aimed to study the clinical courseof anterior wall AMI patients with tombstoning electrocardiographic (ECG) pattern. Methodology: We investigated 46 patients with AMI for tombstoning ECG pattern. Those without tombstoning were also included and compared. Demographic, clinical, laboratory and complications were noted in both the groups of patients. Results: Out of 46 anterior wall AMI patients, typical tombstoning pattern in all the anterior wall ECG leads was seen in 19 (41%) patients. The systolic blood pressure was significantly lower in tombstoning group. CK-MB, the biochemical predictor of infarct size, was significantly higher among patients with tombstoning on ECG as compared to those without tombstoning (89.78±56.53 vs 173.01±107.57, p value < 0.001). Left ventricular ejection fractions were significantly lower in the tombstoning group (43.90±11.35) as compared to the nontombstoning group (52.29±14.01%). The incidence of pre-infarct angina was significantly lower in patients with the tombstoning ECG pattern (21%) compared with those without the pattern (52%). Cardiogenic shock (16% vs 4%), ventricular tachycardia (26% vs 4%), and ventricular fibrillation (16% vs 0%) occurred in a significantly larger percentage of patients with the tombstoning ECG pattern as compared to those without tombstoning on ECG. Conclusions: Patients with tombstoningECG patterns had a larger infarction size, lower left ventricular ejection fraction, with higher in-hospital complications.