Objective: To examine the association between pre-infarction angina (PA) and care-seeking behaviors and its effects on early reperfusion rates for patients with ST-elevation myocardial infarction (STEMI). Methods: Between November 1, 2005 and December 31, 2006, a prospective, cross-sectional, and multicenter survey was conducted in 19 hospitals in Beijing and included consecutive patients with STEMI admitted within 12 h of onset of symptoms. Data were collected by structured interviews and medical records review. Results: PA within 48 h prior to the onset of the infarction occurred in 50.4% of the 498 patients. Prior to seeking care, patients in the PA group more frequently thought the symptoms would go away (61.8% vs. 38.5%, p<0.001) and attempted some form of self-treatment (61.0% vs. 45.3%, p=0.001) than the patients without PA (non-PA group). Median pre-hospital delay in the PA group was longer ( 118 vs. 103 min, p=0.045) than in the non-PA group. The prevalence of ambulance use in the PA group was significantly lower than in the non-PA group (31.5% vs. 43.3%, p=0.007). Multivariate analysis showed that the presence of PA was an independent predictor of pre-hospital delay >2h ( OR 1.863, 95% CI: 1.112-2.765, p=0.013) and non-ambulance use (OR 1.724, 95% CI: 1.185-2.670, p=0.003). In addition, patients in the PA group had a lower early reperfusion rate (74.7% vs. 83.3%, p=0.027), mainly because of a lower incidence of primary percutaneous coronary intervention (58.6% vs. 67.9%, p=0.042). Conclusions: Presence of PA was associated with longer pre-hospital delay, significantly decreased use of ambulance, and lower early reperfusion rates among patients with STEMI. (C) 2008 Elsevier Ireland Ltd. All rights reserved.