ATP binding cassette transporter 1 (ABCB1) plays a critical role in the development and progression of cardiovascular disease. Emerging evidence suggests that common functional polymorphisms in the ABCB1 gene might have an impact on an individual's susceptibility to ischemic heart disease, but individually published results are inconclusive. The MEDLINE (1966-2013), the Cochrane Library Database (Issue 12, 2013), EMBASE (1980-2013), CINAHL (1982-2013), Web of Science (1945-2013), and the Chinese Biomedical Database (CBM; 1982-2013) were searched without language restrictions. Meta-analysis was performed with the use of the STATA statistical software. Odds ratios (OR) with their 95% confidence intervals (95% CIs) were calculated. Seven case-control studies with a total of 2310 myocardial infarction (MI) patients and 10,506 acute coronary syndrome (ACS) patients met the inclusion criteria. Our meta-analysis results indicated that ABCB1 C3435T polymorphism may be associated with an increased risk of MI and ACS, especially among Asian populations (T allele vs. C allele: OR=1.40, 95% CI=1.31-1.49, ph=0.058). Meta-regression analyses showed that clinical subtype and ethnicity may be the main sources of heterogeneity (T allele vs. C allele: OR=1.16, 95% CI=0.97-1.37, ph=0.036). Our findings provide empirical evidence that ABCB1 C3435T polymorphism may contribute to the risk of MI and ACS, especially among Caucasian populations. Thus, detection of ABCB1 C3435T polymorphism may be a promising biomarker for the early detection of MI and ACS.