ABSTRACT BACKGROUND We sought to describe the prognostic value of Q wave location according to Third Universal Definition of Myocardial Infarction in contiguous and in lone leads. METHODS We included individuals with ECG recorded in a general practitioner’s facility from 2001 to 2011. We estimated the risk of all-cause mortality with a multivariable-adjusted Cox proportional hazard model in both contiguous and lone leads. The contagious leads were composed of 5 groups: 2 anterior precordial leads V2-Q wave - V3 and V4-V6, the lateral leads I and aVL, inferior leads II, III and aVF and posterior leads V1-V2-R wave. The lone leads required that the lead group, they were anatomically related to do not have other pathologic Q waves. The reference group included individuals without Q waves and with Q waves in all groups, but the one investigated. RESULTS A total of 90,010 individuals with pathologic Q waves were identified. After a follow-up period of 5 years, there were 10,080 death cases. Having a Q wave in a contiguous leads (V2-Q and wave-V3, I and aVL, V4-V6, II, III and aVF) was associated with significant increased risk of death in almost all the leads, especially contiguous lead V2-Q wave and V3 [hazard ratio (HR): 1.47, confidence interval (95%CI): 1.43–1.53]. While having Q wave in lone leads show varying risk, with the strongest association seen in lead V2-Q wave, V3, aVL and II (HR: 1.33, 95% CI: 1.26-1.40, P <0.001), HR: 1.19, 95% CI: 1.11-1.27, P <0.001), HR: 1.36, 95% CI: 1.29-1.43, P <0.001, HR: 1.89, 95% CI: 1.74-2.06, P <0.001, respectively). CONCLUSIONS Q waves in anterior, lateral and inferior leads were associated with significant risk of death in patients who fulfilled the Third Universal Definition of Myocardial Infarction. In addition, some isolated leads showed also a high risk of death, and therefore a coincidental finding of Q waves in these leads should not be neglected.