This study evaluates the impact of an optimized emergency nursing process on treatment outcomes, prognosis, patient satisfaction and analyzes the relationship between shortened rescue time and myocardial enzyme levels in patients with acute myocardial infarction (AMI). This retrospective study included 201 patients with AMI admitted to our hospital's emergency department between June 2022 and February 2024. Patients were divided into an observation group (n = 93), which received optimized emergency nursing care, and a control group (n = 108), which received standard care. The optimized nursing process encompassed prehospital emergency intervention, rapid transportation, in-hospital treatment, continuous monitoring, and psychological support. Data collected included rescue times, treatment effectiveness, anxiety and depression scores, patient satisfaction, and myocardial enzyme levels. The correlation between rescue time and myocardial enzyme levels was analyzed. Compared with the control group, the observation group demonstrated significantly shorter rescue times, including triage assessment and emergency electrocardiogram examination (P < .05). Clinical outcomes such as ST-segment resolution, chest pain relief, and myocardial enzyme normalization were notably better in the observation group (P < .05). A significant negative correlation was found between rescue time and myocardial enzyme levels in both groups, with correlation coefficients of -0.41 in the observation group and -0.29 in the control group. This indicates that shorter rescue times are associated with faster myocardial enzyme recovery. In addition, the observation group reported significantly lower anxiety and depression levels, higher hope scores, and greater patient satisfaction (P < .05). Optimizing the emergency nursing process significantly improves treatment outcomes and prognosis in patients with AMI by reducing rescue times, enhancing myocardial enzyme recovery, and improving psychological well-being and patient satisfaction. The significant negative correlation between rescue time and myocardial enzyme levels underscores the importance of rapid emergency care. These findings support the implementation of this optimized approach in clinical settings to improve AMI management and patient outcomes.