Objective To describe the lengfh of stay and its trend of AMI patients from western rural area of China and identify potential hospitallevel factors associated with LOS. Methods The study selected patients admitted to 30 hospitals for AMI in 3 years (2001, 2006, and 2011) in 9 provinces from western rural area of China by random sampling. Patient information was obtained from medical record via central abstraction. Hospitals were divided into 3 groups according to the median of LOS. Accounting for differences in case mix and year, patient characteristics were compared across hospitals using the Chisquare test or ANOVA for clustered data. MannKendall trend test was used for testing time trend of LOS in 3 years. Multivariate generalized linear model was used for testing the association between hospital level characteristics and LOS. Results 814 cases were included in the analyses. Significant differences existed in admission time and eGFR concentrations among 3 hospital groups. The average lengty of stay was 14.6±16.6 days in 2001, 11.6±8.7 days in 2006, and 12.2±7.4 days in 2011, respectively, but without time trend (P=0.50). In non-complication subgroup adjusted individuallevel factors, the average LOS were 11.1±8.3, 10.9±6.9 and 11.6±5.7 days, respectively, without time trends (P=0.68). Neither affiliated nor teaching hospitals had on average 6 (95%CI: 1.58 -10.19) days longer LOS than affiliated or teaching hospitals. And hospitals without conducting coronary angiography had 3.7 (95%CI: 0.46-6.99) days longer LOS than those conducting coronary angiography. Conclusion The average LOS for AMI in western rural area of China was not satisfactory. The average length of stay for AMI was not significantly improved in western rural China from 2001 to 2011. Further improvement of AMI care in western rural area of China is critical to raise the level of diagnosis and treatment of AMI.