BackgroundIt is widely known that the incidence rate and short-term mortality of acute myocardial infarctions (AMIs) are generally higher during the winter months. The goal of this study was to determine how the temperature of the environment influences fatal acute myocardial infarctions in Xuzhou.MethodsThis observational study used the daily meteorological data and the data on the cause of death from acute myocardial infarction in Xuzhou from January 1, 2018, to December 31, 2020. After controlling meteorological variables and pollutants, the distributed nonlinear lag model (DLNM) was used to estimate the correlation between temperature and lethal AMI.ResultsA total of 27,712 patients with fatal AMI were enrolled. 82.4% were over the age of 65, and 50.9% were men. Relative to the reference temperature (15 ℃), the 30-day cumulative RRs of the extremely cold temperature (− 2 ℃) for the general population, women, and people aged 65 years and above were 4.66 (95% CI: 1.76, 12.30), 15.29 (95% CI: 3.94, 59.36), and 7.13 (95% CI: 2.50, 20.35), respectively. The 30-day cumulative RRs of the cold temperature (2 ℃) for the general population, women, and people aged 65 years and above were 2.55 (1.37, 4.75), 12.78 (2.24, 5.36), and 3.15 (1.61, 6.16), respectively. No statistically significant association was observed between high temperatures and the risk of fatal AMI. The influence of the cold effect (1st and 10th) was at its peak on that day, and the entire cold effect persisted for 30 days. Temperature extremes had an effect on the lag patterns of distinct age and gender stratifications.ConclusionAccording to this study, the risk of fatal AMI increases significantly in cold weather but not in hot weather. Women above the age of 65 are particularly sensitive to severe weather events. The influence of frigid weather on public health should also be considered.