Background　MicroRNA(miRNA) are a class of endogenous non-coding small RNA molecules which cause degradation or translational inhibition of genes, and they are involved in the differentiation and proliferation of cells, electrical conduction, apoptosis and angiogenesis. A bulk of studies implicate miRNA in physiological and pathological adaptations in myocardial ischemia reperfusion injury (I/RI) through regulating relevant signaling pathways.　Objective　To review articles studying the potentially regulatory roles of the miRNA in the development of myocardial I/RI and the cardioprotection of ischemic preconditioning (IPC) before I/RI.　Content　This article reviews the modification of miRNA in the pathophysiology of myocardial I/RI, including arrhythmia, cardiomyocyte survival and death, angiogenesis, etc. It has been demonstrated that miRNA cause arrhythmia probably via disturbing the electrical conductance, affecting the action of angiotensin, and interfering intracellular calcium. Some miRNA can be affected by radical oxygen species to regulate signaling pathways that modulate cell survival, and determine the fate of cardiomyocytes. On the other hand, several miRNA have been shown to bidirectionally modulate angiogenesis. Additionally, multiple miRNA are demonstrated to play an important role in the cardioprotection of ischemic preconditioning.　Trend　The miRNA, involved in the development and progress of I/RI, can be therapeutic targets or sensitive diagnostic biomarkers for I/RI. Further investigations are demanded to find specific biomarkers.