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After an emergency operation that lasted for around four hours, Ito was kept alive for some time by an artificial heart and lungs but died at 2:28 a.m. local time due to loss of blood, a police spokesman said.
Doctors had told a news conference that two bullets had reached his heart.
TV footage earlier showed the mayor lying face down on a sidewalk with his eyes closed as paramedics performed cardiopulmonary resuscitation after he was gunned down.
"I hope the truth will be revealed through vigilant investigation by authorities," Kyodo news agency quoted Prime Minister Shinzo Abe as saying.
Japan has very strict gun control laws and firearms are mostly in the hands of "yakuza" gangsters or hunters.
Nagasaki , on the southernmost main island of Kyushu and some 610 miles southwest of Tokyo, was the second city to suffer an atomic bombing by the United States on August 9, 1945.
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