Objective <p>To systematically review the clinical efficacy of amiodarone in the treatment of myocardial infarction in prehospital emergency.</p> Methods <p>Articles related to the use of amiodarone in prehospital emergency treatment of myocardial infarction were retrieved from PubMed, Cochrane Library, EMBASE, Wanfang, VIP and CNKI databases, and the retrieval time was from the establishment of the database to October 31 2024. Meta-analysis and risk bias evaluation were carried out with R 4.2.2 software, and the results were considered statistically significant when <i>P</i> &lt; 0.05.</p> Results <p>A total of 16 studies involving 832 patients receiving prehospital amiodarone and 800 control patients were included in this systematic review and meta-analysis. Pooled results demonstrated that, compared to the control group, amiodarone significantly reduced the incidence of malignant arrhythmia (RR = 0.29, 95% CI: 0.22 to 0.37, <i>P</i> &lt; 0.01), decreased the average number of defibrillations (MD = -2.40, 95% CI: -2.61 to -2.19, <i>P</i> &lt; 0.01), improved the success rate of rescue (RR = 1.16, 95% CI: 1.12 to 1.21, <i>P</i> &lt; 0.01), lowered the recurrence rate of myocardial infarction (RR = 0.22, 95% CI: 0.13 to 0.35, <i>P</i> &lt; 0.01), reduced the incidence of adverse reactions (RR = 0.33, 95% CI: 0.12 to 0.87, <i>P</i> = 0.02), and shortened the length of hospital stay (MD = -3.81, 95% CI: -4.02 to -3.59, <i>P</i> &lt; 0.01).</p> Conclusion <p>This systematic review and meta-analysis demonstrated that prehospital amiodarone administration in patients with myocardial infarction significantly reduced the incidence of malignant arrhythmia and the average number of defibrillations, while improving the success rate of rescue. Furthermore, it lowered the incidence of adverse reactions, the recurrence rate of myocardial infarction, and shortened the length of hospital stay. These findings support the clinical promotion of amiodarone in prehospital emergency care for myocardial infarction.</p>