Background: Coronary artery disease (CAD) is the second highest cause of mortality in Hong Kong. The most significant manifestation is acute myocardial infarction (AMI). Both treatment and cardiac rehabilitation for AMI are costly. Knowledge of the cost of management of AMI is important for better planning for allocation of medical resources. The present study aims to evaluate and describe the cost of management of patients with explicit Q-wave AMI in a local public hospital in Hong Kong. Methods: A retrospective study was performed of patients admitted to the United Christian Hospital in Hong Kong. The study cohort consisted of patients who were aged ≥18 years with a diagnosis of Q-wave AMI from 1 January 2000 to 31 December 2000 admitted to the coronary care unit. Cost items studied included hospital stay, outpatient clinic visits, diagnostic tests, medications, and percutaneous coronary interventions. Results: Ninety-five cases were evaluated. The average annual medical cost per patient for AMI management in the year 2000 was $US9323.4 ± 5792 ($US1 = HK$7.8). The total annual cost per patient increased with the complexity of the disease from $US7745 ± 6245 for non-fatal AMI without procedure to $US12 344 ± 3129 for non-fatal AMI with procedure. Based on the local epidemiological data, the prevalence rate of CAD is 2.2% and assuming 3% of patients with CAD may experience AMI with medical care, the estimated total cost of AMI management in Hong Kong was $US45 million per year or 0.5% of the 2000-2001 total healthcare expenditure. Conclusion: This study provides information on the cost of AMI management in a local hospital of Hong Kong. Public awareness of CAD and the implementation of appropriate health measures should be reinforced.