Abstract Background: Different methods have been suggested to improve the limited diagnosing accuracy of exercise electrocardiography in women. To the best of our knowledge, the methods developed lucks comprehensive comparison of a lead-by-lead basis in all 12 electrocardiographic leads. This study aimed to compare the diagnostic performance of ST segment depression and T wave Alternans at peak, 1 minute and 3 minutes after recovery from exercise in each lead. Methods: The study analyzed 245 women from two different categories participating in the Finnish Cardiovascular Study. Out of 245 women, 138 with angiographically proven coronary artery disease (age 62.1±9.5) and 107 with a low likelihood of coronary artery disease (age 47.3±13.5) were analyzed. Receiver operating characteristic curve analysis was performed to evaluate the overall diagnostic performance of the variables in all 12 leads for predicting coronary artery disease in women. Results: The areas under the receiver operating characteristic curve for ST segment depression at peak, 1minute and 3 minutes after recovery from exercise in leads I and V5 were 0.84, 0.81, 0.84, 0.80, and 0.85, 0.81, respectively. All chest leads except V1 achieved 80% area under the receiver operating characteristic curve. Leads aVL and V1 showed limited diagnostic performance. Lead aVL showed the highest areas under the receiver operating characteristic curve (0.79 and 0.83), respectively at 1 and 3 minutes after recovery from exercise in T wave alternans. Conclusions: This study suggests that the limited diagnostic accuracy of ST segment depression in women to detect coronary artery disease can be improved by determining the appropriate lead selection in recovery phase. Analyzing lead aVL in T wave alternans approach increases the diagnostic ability of coronary artery disease in women.