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Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Among these, myocardial infarction (MI) represents the most prevalent and devastating form, contributing significantly to global morbidity and mortality. Reducing the mortality and long\u2010term complications associated with MI is therefore both necessary and urgent. Exosomes, naturally occurring extracellular vesicles, offer a promising cell\u2010free alternative for drug delivery and cardiac repair and regeneration after ischemic injury due to their ability to transport bioactive proteins, lipids, and RNA. This narrative review summarizes recent advancements in exosome\u2010based therapeutics for ischemic heart disease, focusing on the efficacy of various animal models. Various approaches are being studied to optimize exosome\u2010based therapies, including methods to enhance their stability, targeting ability, and bioavailability in the cardiovascular system, highlighting the potential of exosomes not only as drug delivery vehicles but also as regenerative mediators capable of promoting myocardial repair and reducing MI. 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