Abstract: Human and animal health will be seriously harmed by myocardial infarction, the diagnostic speed and the therapeutic effect of this disease need to be improved urgently. As the natural carrier for delivering cell information, some microRNAs (miRNAs) found in exosomes can reflect and act on the pathological changes caused by myocardial infarction for effective diagnosis and treatment. The feasibility of exosomal miRNAs (e.g. miR-4516, miR-203, and miR-1915-3p) from different sources as diagnostic agents for myocardial infarction, as well as the research progresses in relief of cell death via apoptosis (e.g. miR-21a-5p, miR-30e, and miR-210), autophagy (e.g. miR-125b-5p, miR-301, and miR-143-3p), pyroptosis (e.g. miR-182-5p, miR-133a, and miR-100-5p), and ferroptosis (e.g. miR-26b-5p and miR-23a-3p), promotion of forming new blood vessels (e.g. miR-29b-3p, miR-210-3p, and miR-494-3p), and inhibition of inflammatory response (e.g. miR-25-3p, miR-182-5p, and miR-671) for intervention therapy of myocardial infarction were reviewed here to provide new strategies for the diagnosis and treatment of myocardial infarction.