By multivariate analysis, an ischemic ECG showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65‐40.94, P<0.0001). Isolated T‐wave abnormality was significantly more prevalent in edema‐positive versus edema‐negative subjects (41.1% versus 6.7%, P=0.001). Of 30 edema‐negative subjects, 24 (80%) had normal/nonischemic ECGs. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic ECG, 25 isolated T‐wave abnormalities, 11 isolated ST depression, and 14 ST depression+T‐wave abnormality. Myocardial edema was determined by expert review of T2‐weighted images. ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST‐ or T‐wave abnormalities, isolated T‐wave abnormality, isolated ST depression, ST depression+T‐wave abnormality. Twelve‐lead electrocardiography ( ECG) and cardiac magnetic resonance with T2‐weighted imaging were acquired before invasive coronary angiography. Secondary analysis of a previously enrolled prospective cohort of patients presenting with non‐ ST‐segment elevation acute coronary syndromes was conducted. Journal of the American Heart Association (JAHA).Stroke: Vascular and Interventional Neurology.Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).