Objective To study the choice of diagnostic and therapeutic strategy for young patients with acute myocardial infarction (AMI) according to the onset characteristics. Methods We retrospectively analyzed the clinical data of 36 young and 1 283 elderly patients with AMI, who were treated between Dec. 2006 and Jan. 2012 in our hospital. The risk factors, clinical characteristics and diagnosis/treatment strategies were analyzed. Results (1) The young patients accounted for 2.7% of all the AMI patients in our study, with most of them being male (97.2%). AMI with ST-segment elevation accounted for 94.4% (34/36) among the young AMI patients, often with risk factors like smoking and dyslipidemia, scarcely with hypertension or diabetes. In the young patients the incidence rates of cardiogenic shock, heart failure and arrhythmia were 5.6% (2/36), 16.7% (6/36), and 5.6% (2/36, respectively, and there was no death during treatment or follow-up. (2) Among the 33 young patients receiving coronary angiography, 21 (63.6%) had single vessel lesions, mostly involving the left anterior descending artery and resulting in anterior myocardial infarction. Among the 15 young AMI patients who received emergent coronary angiograpy, 6 (40%) had heavy thrombus burdern but had slighter coronary stenosis, and they did not receive stent treatment. Conclusion AMI should be considered when young male patients with smoking history, dyslipidemia and chest pain. Young AMI patients often have single vessel lesions and better prognosis, and they need timely revascularization.