Abstract: Cardiac ischemic events are common cardiovascular events caused by insufficient blood supply of coronary arteries. Their acute development can lead to cardiomyocyte necrosis threatening patient life, while chronic pathological cardiac remodeling contributes to heart failure. Extracellular vesicles, potentially offering swift and precise diagnostic biomarkers, engage in various pathophysiological processes of cardiac ischemic events. In addition, different extracellular vesicles show cardioprotective effect that may benefit treatment of cardiac ischemic events, especially in the field of cardiac regeneration. This article reviewed multifaceted roles of extracellular vesicles in diagnosing and treating cardiac ischemic events.