Aim - to compare risk factors and pathological features of fatal myocardial infarction after emergency abdominal surgery and that not associated with operations. Material and methods. It was performed retrospective comparative analysis of medical records and autopsy data of 67 patients who died from acute myocardial infarction (AMI) after emergency abdominal surgery and 100 randomly selected patients who died from myocardial infarction without operations in multi-field hospital of Moscow for the period 2000-2012. Results. There were no significant differences in age, gender, cholesterol level, previous myocardial infarction, stroke, diabetes and obstructive pulmonary disease between groups. Surgical patients were more likely to have anemia (73.1 vs 24.0%; p=0.001), pneumonia (14.9 vs 2.0%; p=0.006) and advanced peritonitis (40.3 vs 0%; p<0.001). Coronary stenoses >50% were found in 73 and 80% of patients respectively (p>0.05), but surgical patients less frequently had multivascular lesion (28.4 vs 45.0%; p=0.03) and none had coronary artery thrombosis (0 vs. 26% in case of conventional MI). Left ventricular hypertrophy was observed in most of patients in both groups, previous MI in 41.8 and 51.0% (p>0.05), fatty myocardial degeneration in 67.2% of postoperative and 44% of «conventional» patients (p=0.003). All postoperative myocardial infarctions were diagnosed posthumously. Over 40% of them have developed after more than 3 days after surgery. Conclusion. Our data found prevalence of MI type 2 after emergency abdominal surgery. Patients with high risk of myocardial infarction who need for prolonged postoperative cardiological monitoring and more active management should be determined using conventional cardiovascular risk factors and presence of anemia, pneumonia and peritonitis.