Abstract: Acute myocardial infarction is an acute ischemic and hypoxic disease in the cardiovascular system. It is pathologically characterized by complete or incomplete occlusion of the coronary arteries, resulting in a large loss of cardiomyocytes. Long non-coding RNAs (lncRNAs) are a type of ribonucleic acids that do not have protein coding function and can exist stably in exosomes. The current study has found that lncRNAs have a regulatory effect on epigenetics, transcription and post-transcriptional levels. LncRNAs can be transported to the cardiovascular system under the encapsulation of double-layer lipid vesicles-exosomes to regulate the autophagy, apoptosis and fibrosis of cardiomyocytes, endothelial cells and vascular smooth muscle cells, and regulate the occurrence and development of acute myocardial infarction from the biological genetic level. This article mainly introduces how lncRNAs derived from exosomes regulate the pathological changes and related progress of acute myocardial infarction at the genetic level.