Abstract: Objective To analyze the clinical characteristics of ST segment elevation in elderly patients with acute myocarditis. Methods A retrospective analysis was conducted in 62 patients with acute myocarditis from February 2010 to March 2016 in our hospital. According to electrocardiogram, 34 cases were divided into ST-segment elevation group and28 cases in non-ST segment elevation group. The general situation, clinical manifestation, laboratory examination, echocardiography, coronary angiography, treatment data and adverse events were compared between the two groups. Results Compared with non-ST segment elevation group, the heart rate of ST segment elevation group was higher, and the systolic blood pressure and the diastolic blood pressure of ST segment elevation group were lower (P < 0.05). There were 21 patients with acute fulminant myocarditis in the ST segment elevation group and 9 in the non-ST segment elevation group, the difference was statistically significant (P < 0.05). ST segment elevation group of white blood cell count, peak creatine kinase (CK), creatine kinase isoenzyme MB (CKMB) peak and troponin I (Tn Ⅰ) peak is higher than non-ST segment elevation group, the difference was statistically significant (P < 0.05). Adverse reactions occurred during hospitalization in both groups, among which cardiogenic shock (26.47%), ventricular fibrillation (14.71%) and inpatient mortality (20.59%) in the ST elevation group were higher than those in the non-ST elevation group. Conclusion ST-segment elevation in elderly patients with acute myocarditis acute onset and severe has higher risk than non-ST segment elevation elderly patients with acute myocarditis, should be timely and correctly treatment, the rational application of mechanical adjuvant therapy, can reduce the incidence of adverse reactions.