Abstract: Objective To study the clinical features of acute myocardial infarction（AMI） after craniotomy and its diagnosis and treatment.Methods Clinical data about 1991 patients who developed AMI after craniotomy in our hospital from January 2010 to November 2010 were retrospectively analyzed.Results Of the 1991 patients after operation,4 had AMI,1 had the tracheal intubation not removed,3 had precordial pain,2 had shock,1 had arrhythmia and acute left heart failure,2 died,and 2 recovered.Their CK,CK-MB and TnT levels increased persistently,with a peak value of 1 800U/L,72ng/mL and 2.15ng/ml,respectively,within 24h after operation.Conclusion Craniotomy can induce the onset of AMI,which may be due to intraoperative hypotension,the use of hemostatics,pain,stress,and related diseases.Electrocardiographic abnormalities in patients with subarachnoid hemorrhage can confuse the early diagnosis of peroperative AMI.Preoperative evaluation and monitoring,early diagnosis,rational use of anticoagulants and anti-platelet therapy can decrease its mortality and risk of rebleeding.