Objective — to compare myocardial infarction (MI) mortality rates in the regions of the Russian Federation in 2006 and 2015. Material and methods. The study used the requested Russian Federal State Statistics Service data on the average annual population size and the number of the deceased by the causes of death on the basis of the Brief Nomenclature of Causes of Death. The standardized mortality rates (SMRs) were calculated using the European standard and software. SMRs were estimated by I21.0—I21.9 (Acute MI), I22.0—I22.9 (Recurrent MI), and two above rubrics. For comparison of SMRs in 2006 and 2015, the investigators determined the mean SMR values in the regions, standard deviation, and the maximum and minimum values, calculated the absolute values of gain/loss, and specified the indicators of clarity. The significance of differences was estimated using the χ2 and nonparametric tests for quantitative characteristics. Results. The average SMRs from MI (codes I21—I22) was 40.2±20 in 2006 and 36.9±16.9 in 2015; the average reduction in SMRs was 3.3±12.5 (5.3±28.2%; p<0.0001). A statistically significant reduction in mortality rates from MI (codes I21—I22) occurred in 32 regions. There was a decline in all three indicators (codes I21—I22; code I21 and code I22 separately) in 29 (36.3%) regions and an increase in 18 (22.5%) regions. A decline in acute MI SMRs and an increase in recurrent MI ones were recorded in 24 regions; and SMRs from acute MI increased and those from recurrent MI decreased in 9 regions. The maximum increase in MI SMRs (94%) was registered in the Ulyanovsk Region (52 and 170% increases in SMRs from acute and recurrent MI, respectively). There were the maximum SMRs from MI and those from acute and recurrent MI in both 2006 and 2015 in the Magadan Region. Conclusion. A change in approaches to organizing medical care for acute coronary syndrome in most regions of the Russian Federation resulted in a reduction in MI mortality rates. The ambiguous and antagonistic change in the trends of acute and recurrent MI SMRs in some regions of the Russian Federation needs to be further analyzed (including approaches to filling out a medical death certificate).