Innate immunity has been studied for several decades in the context of ischaemia-reperfusion injury, myocardial remodelling, and healing. In the last years, a number of experimental and clinical studies focused on adaptive immunity in these processes. Meanwhile, there is considerable evidence especially on the role of CD4⁺ T-cells in myocardial injury and healing, whereas their role in remodelling is less clear. Innate leukocytes are able to recognize a wide array of self and foreign molecular patterns, whereas the activation of adaptive immunity requires the highly specific cooperation of antigen-presenting cells and distinct antigen-specific receptors on lymphocytes. Relevant autoantigens have not yet been definitely identified but experimental evidence indicates that autoantigen recognition is necessary for T-cell activation after myocardial infarction. Non-antigen-specific modes of activation might also play a role especially during acute ischaemia and reperfusion of the myocardium. This review summarizes the current evidence from experimental studies and presents side-by-side recent clinical data on the role of T cells in the pathophysiology of myocardial reperfusion injury and post myocardial infarction healing.