Myocardial ischemic injury is a pathological process with an insufficiency of blood supply to the myocardium mainly caused by partial stenosis or complete obstruction of coronary arteries, which may develop heart failure in severe cases. Adaptive immunity participates in the pathophysiological process of myocardial ischemic injury, and plays an important role in myocardial repair after ischemic injury as well. The present review focuses on the functions and mechanisms of the adaptive immunity involving T cells, B cells, natural killer (NK) cells, and dendritic cells (DCs), as well as the cell interactions mediated by adaptive immune cells in myocardial ischemic injury. In depth analysis of the dynamic changes of adaptive immunity in myocardial ischemic injury and the interaction network of different immune cell subpopulations, as well as the development of novel chimeric antigen receptor (CAR) cell therapy, antibody therapy, and personalized immunotherapy strategies, are expected to bring new hope for the treatment of clinical myocardial ischemic injury.