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Background  Chinese and  U.S.  guidelines recommend angiotensin‐converting enzyme inhibitors ( ACEIs )/angiotensin receptor blockers ( ARBs ) for all patients with acute myocardial infarction ( AMI ) in the absence of contraindications as either a Class I or Class  II a recommendation. Little is known about the use and trends of  ACEI / ARB  therapy in China over the past decade.    Methods and Results  Using nationally representative data from the China Patient‐centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction (China  PEACE ‐Retrospective  AMI  Study), we assessed use of  ACEI / ARB  therapy in 2001, 2006, and 2011, overall and across geographic regions and strata of estimated mortality risk, and predictors of  ACEI / ARB  therapy, among patients with Class I indication by Chinese guidelines. The weighted rate of  ACEI / ARB  therapy increased from 62.0% in 2001 to 71.4% in 2006, decreasing to 67.6% in 2011. Use was low across all 5 geographic regions. By strata of estimated mortality risk, in 2001, rates of therapy increased with increasing risk; however, by 2011, this reversed and those at higher risk were less likely to be treated (70.7% in lowest‐risk quintile vs. 63.5% in the highest‐risk quintile;  P <0.001).    Conclusion  One third of Chinese  AMI  patients with Class I indications do not receive  ACEI / ARB  therapy during hospitalization, with little improvement in rates over time. Patients at higher mortality risk in 2011 were less likely to be treated, highlighting important opportunities to optimize the use of this cost‐effective therapy.    Clinical Trial Registration  URL: ClinicalTrials.gov. Unique identifier: NCT01624883.

journal of the american heart association

Patterns of Use of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Among Patients With Acute Myocardial Infarction in China From 2001 to 2011: China  PEACE ‐Retrospective  AMI  Study