The complexity of posttranscriptional regulation by noncoding microRNAs (miRNAs, miRs) is still not completely understood. A large fraction of the genome is under the control of miRs via (partial) complementary base pairing within the corresponding mRNA region. Myocardial infarction is characterized by strongly altered gene expression, deregulation of underlying signaling pathways, and crucial participation of several miRs in this context. Mechanistically, miR induction or repression after myocardial infarction triggers downstream events in a cell-type–specific manner, and interference with endogenous miR expression might regulate overall cardiac function. In this brief review, we (1) summarize the current knowledge about the importance of several miRs after myocardial infarction, (2) report about novel miR-based therapeutic approaches to counteract maladaptive remodeling upon cardiac ischemia, and (3) discuss briefly the use of miRs as biomarkers for cardiac ischemia.