Objective To investigate the key points for management of subclinical and agonal types of penetrating cardiac trauma (PCT). Methods A retrospective analysis was conducted on clinical data of 135 PCT cases treated from January 2005 to March 2012. The cases were divided into subclinical type, clinical type (cardiac tamponade or hemorrhagic shock types) and agonal type. Managements of the two extreme types including subclinical type and agonal type were studied in groups. Results （1）Thirty cases of subclinical type failed to have timely diagnosis and treatment due to the withdrawal from in-hospital observation, which resulted in 22 deaths. Eleven cases of subclinical type had timely diagnosis through in-hospital observation or cardiac exploration, but three cases died in operating room thoracotomy (ORT). There were 27 cases of agonal type, but 15 died in ORT and two died in emergency room thoracotomy (ERT). Of 67 cases of clinical type, seven died in ORT. （2） A total of 86 cases survived ORT or ERT after timely diagnosis or diagnosis through in-hospital observation plus cardiac exploration. In the meantime, sound recovery was observed in 3-24 months of follow-up. Conclusion Success rate in treatment of PCT can be enhanced by close observation and timely cardiac exploration for subclinical type PCT and by timely ERT and bleeding control for agonal type PCT.