Purpose: To assess clinical practices and in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) in Beijing, China. Methods: This study was a prospective multicentre registry study in Metropolitan Beijing, China. Demographics, delay time, management strategy and in-hospital outcome data were collected from patients with STEMI enrolled in 19 hospitals. Results: A total of 803 patients (mean age 61 +/- 13 yr,22% women and 42.1% 65 yr) with STEMI were enrolled. More than half had a history of hypertension (50.4%) and current smoking (55.2%). Six hundred and fifty patients (80.9%) received reperfusion trerapy: 124 (15.4%) treated with thrombolysis and 526 ( 65.5%) with primary percutaneous coronary intervention (PCI). The median door-to-needle time for thrombolysis was 83 min and door-to-balloon time for primary PCI was 132 min. Only 7% of patients treated with thrombolysis met the guidelines goal of the door-to-needle time <= 30min and 22% of patients had PCI performed in <= 90 min. Aspirin was prescribed in 97.8% of patients, low molecular weigh heparin in 92%, statins in 91.0%, beta-blockers in 76.7%, ACE inhibitors in 73.5%, clopidogrel in 89.7% and GP IIb/ IIIa antagonists in 19.3%. In-hospital mortality was 5.4%. Conclusion: Recommended Clinical Guidelines treatments are largely implemented in patients with STEMI in Beijing. However, many patients were not reperfused within the recommended times. There remains important potential for improvement in the administration of reperfusion therapy.