A seven-parameter advanced electrocardiography (A-ECG) algorithm demonstrated 90% sensitivity for detecting coronary artery disease in patients with chest pain, validated across 933 participants and prognostically confirmed in 27,239 UK Biobank participants over nearly two years of follow-up. The algorithm combines conventional ECG readings with vectorcardiography and waveform complexity measures to achieve an area under the curve of 0.72. The high sensitivity makes this particularly valuable for ruling out coronary disease, with a 70% negative predictive value meaning seven in ten patients with negative A-ECG scores truly lack coronary plaques on CT angiography. This represents a meaningful advance over conventional ECG, which notoriously underperforms in stable chest pain evaluation. The scalable, low-cost nature could transform emergency and outpatient chest pain triage, potentially reducing unnecessary advanced imaging while maintaining diagnostic confidence. However, the 31% specificity indicates many patients without disease would still test positive, limiting standalone diagnostic utility. The prognostic validation strengthens clinical relevance, showing higher scores predict future cardiovascular events independent of traditional risk factors. As a preprint awaiting peer review, these promising results require validation through the formal scientific review process before clinical implementation.