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BACKGROUND: Myocardial infarction is one of the catastrophic complications after total joint arthroplasty. However, the risk factors and predictive model have not been reported in previous research after total joint arthroplasty. OBJECTIVE: To study the incidence and risk factors of myocardial infarction after total joint arthroplasty, and develop a nomogram for predicting the myocardial infarction after total joint arthroplasty. METHODS: We retrospectively reviewed the data of 5 746 patients who underwent total hip arthroplasty or total knee arthroplasty in the Affiliated Hospital of Qingdao university and the People’s Hospital of Xixiu District between September 2013 and July 2017. The baseline characteristic, preoperative comorbidities, preoperative examinations, operative data, other hospital information and follow-up data were collected, recorded and were used to analyze the risk factors of myocardial infarction. In addition, a nomogram was developed based on the independent risk factors for predicting the myocardial infarction after total joint arthroplasty, and receiver operating characteristic curve and calibration curve were used to evaluate the nomogram. RESULTS AND CONCLUSION: Forty-eight patients affected myocardial infarction within 14 days after total joint arthroplasty, and the incidence of myocardial infarction was 0.8%. Multivariate Logistic analysis indicated that age-adjusted Charlson Comorbidity Index, anesthesia type and atrial fibrillation were independent risk factors for postoperative myocardial infarction (P < 0.05). The risk of myocardial infarction in patients with age-adjusted Charlson Comorbidity Index ≥ 5 was higher than patients with age-adjusted Charlson Comorbidity Index < 5. The risk of myocardial infarction in patients receiving general anesthesia was higher than that of patients receiving epidural/lumber anesthesia. The risk of myocardial infarction in patients combined with atrial fibrillation was higher than that in patients without it. Receiver operating characteristic curve showed that the nomogram has a high degree of discrimination (AUC=0.730, 95%CI: 0.661-0.799), and the calibration curve showed that the model had a high degree of calibration. A predictive model based on age-adjusted Charlson Comorbidity Index, anesthesia type and atrial fibrillation can accurately predict the myocardial infarction following total joint arthroplasty. [ABSTRACT FROM AUTHOR]