Background:Since 2010,two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology.However,little is known about the changes in clinical characteristics,management,and in-hospital outcomes in rural areas.Methods:In the present multicenter,cross-sectional study,participants were enrolled from rural hospitals located in Liaoning province in Northeast China,during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015).Data collection was conducted using a standardized questionnaire.In total,607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts,respectively.Results:STEMI patients in rural hospitals were older in the second group (63 years vs.65 years,P =0.039).We found increases in the prevalence of hypertension,prior percutaneous coronary intervention (PCI),and prior stroke.Over the past 5 years,the cost during hospitalization almost doubled.The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34％ to 54.47％ (P ＜ 0.0001).Concurrently,the proportion of primary PCI increased from 3.62％ to 10.52％ (P ＜ 0.0001).The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations.However,in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01％ vs.10.20％,P =0.121;13.34％ vs.13.66％,P =0.872).Conclusions:Despite the great progress that has been made in guideline-recommended therapies,in-hospital outcomes among rural STEMI patients have not significantly improved.Therefore,there is still substantial room for improvement in the quality of care.