Abstract: AIM:To analyze the risk and death-causing factors of in-hospital death in acute myocardial infarction patients treated with emergency percutaneous coronary intervention (PCI). METHODS: Four hundred and thirty-eight AMI patients treated with emergency PCI were divided into death group (21 cases) and survival group (417 cases). Clinical features, coronary arteriography and intervention treatment results of the two groups were compared and the risk and death-causing factors of in-hospital death were analyzed. RESULTS: In death group, the rates of patients >65 years old, cardiac function with Killip class II or higher, cardiogenic shock, extensive anterior wall infarction, multiple branch occlusion (≥2), proximal occlusion, IRA opening immediately TIMI flow grade II or less and decrease of blood pressure were significantly different from those in the survival group (P<0.05). Multivariate logistic regression analysis showed that age >65 years old, cardiac function Killip class II or higher, cardiogenic shock, extensive anterior wall infarction, and IRA opening immediately TIMI flow grade II or less were independent predictors of death in emergency PCI patients. Cardiogenic shock (eight cases, 38.1%) and malignant arrhythmia (six cases, 28.6%) were the first and second leading causes of death. CONCLUSION: In patients >65 years, cardiac functional grading of Killip II or higher, cardiogenic shock, extensive anterior wall infarction, and IRA opening TIMI flow grade II or less are the perioperative risk factors for death in patients treated with emergency PCI. Cardiogenic shock and malignant arrhythmia are the main causes of death in emergency PCI surgical patients during hospitalization.