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Manhattan Mayhem IV featured professional wrestling matches, which involved different wrestlers from pre-existing scripted feuds, plots, and storylines that played out on ROH's television programs. Wrestlers portrayed villains or heroes as they followed a series of events that built tension and culminated in a wrestling match or series of matches.
- Tommaso Ciampa (w/ Mia Yim, Mr. Ernesto Osiris, Prince Nana & RD Evans) defeated Grizzly Redwood (7:54)
- The All-Night Express (Kenny King & Rhett Titus) defeated The Briscoes (Jay Briscoe & Mark Briscoe) (14:04)
- The Kings Of Wrestling (Chris Hero & Claudio Castagnoli) (w/ Sara Del Rey & Shane Hagadorn) defeated The Latin American Exchange (Hernandez & Homicide) (17:13)
- Eddie Edwards defeated Roderick Strong (w/ Truth Martini) (c) to win the ROH World Championship (25:36)
|2011 Ring of Honor Events|
Champions Vs. All Stars • Only The Strong Survive • SoCal Showdown II • World's Greatest • 9th Anniversary Show • Defy Or Deny • Manhattan Mayhem IV • Honor Takes Center Stage • Revolution: USA • Revolution: Canada • Supercard of Honor VI • Best in the World • Tag Team Turmoil • No Escape • Death Before Dishonor IX • Gateway To Honor • Survival Of The Fittest • Glory by Honor X • Southern Defiance • Northern Aggression • Final Battle