〔Abstract〕 Objective To observe the effect of early-warning grading and scoring management in the care of patients with Acute myocardial infarction (AMI) complicated with heart failure in the coronary care unit (CCU). Methods Retrospective analysis was performed on the data of 92 AMI patients with heart failure who received treatment in Jinshui District General Hospital of Zhengzhou from January 2020 to November 2020. All patients were admitted to CCU and divided into a control group with 43 cases and an observation group with 49 cases according to their admission time. The control group was given routine nursing management, and the observation group was given early-warning grading grading management based on the control group. The two groups were compared in terms of length of stay (CCU length, total length of stay), incidence of adverse nursing events, nursing quality of nursing staff, and nursing job satisfaction of family members. Results The length of CCU stay and total length of stay in the observation group were significantly shorter than those in the control group, and the differences were statistically significant (P < 0.05). The incidence of adverse nursing events in the observation group was 4.08 %, significantly lower than 20.93 % in the control group, and the difference was statistically significant (P < 0.05). The scores of early warning evaluation, service attitude, emergency treatment and basic nursing of nursing staff in the observation group were higher than those in the control group, and the differences were statistically significant (P < 0.05). The scores of nursing standardization, nursing professionalism, nursing timeliness and nursing affinity in the observation group were higher than those in the control group, and the differences were statistically significant (P < 0.05). Conclusion The application of early-warning grading and scoring management in the nursing of AMI patients with heart failure admitted to CCU can effectively improve the nursing quality, reduce the risk of adverse nursing events, shorten the length of hospital stay, and improve the nursing work satisfaction of family members.