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Background: The prognosis of patients with acute myocardial infarction (AMI) in the initial stage of the coronavirus disease 2019 (COVID-19) outbreak has been reported globally. However, the reports on the prognosis of patients with AMI after the initial stage of the pandemic are limited worldwide., Methods: This retrospective observational study utilized data from the electronic medical records system of the Oita University Hospital. This study encompassed patients who were hospitalized at our hospital for AMI treatment between April 2018 and June 2022. The study period was categorized into the following three periods: the pre-pandemic period (April 2018 to March 2020), the first phase of the pandemic (April 2020 to March 2021), and the second phase of the pandemic (April 2021 to June 2022). The primary outcome was the duration from the initial admission for AMI treatment to the onset of major adverse cardiac events (MACE). The secondary outcome was the duration from the initial admission for AMI treatment to death from any cause. These outcomes were compared among patients with AMI admitted during the three periods., Results: The one-year MACE-free survival rates did not differ significantly among the three periods (p = 0.146), whereas the one-year overall survival rates were significantly different (p = 0.022). Univariate Cox regression analysis showed that patients with AMI had poorer overall survival in the second phase of the COVID-19 pandemic compared to the pre-pandemic period (hazard ratio {HR}: 4.92, 95% confidence interval {CI}: 1.27-19.09, p = 0.021). However, multiple regression analysis did not show significant differences in the overall survival of patients with AMI across the three periods (HR: 2.77, 95% CI: 0.59-12.96, p = 0.196)., Conclusion: The long-term impact of the COVID-19 pandemic on the prognosis of patients with AMI remains unclear. Further research is required to clarify the long-term impact by using larger cohorts that include pre-hospital data., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Medical Ethics Committee of the Oita University issued approval #2674. This study was conducted in accordance with the Declaration of Helsinki and Ethical Guidelines for Medical and Health Research Involving Human Subjects, as provided by the Ministry of Health, Labour, and Welfare of Japan. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Sato et al.)