Aim To evaluate trend of early aspirin therapy in patients with acute myocardial infarction (AMI) in western rural hospitals in China from 2001 to 2011, and to identify independent factors associated with the use of early aspirin. Methods Two stage random sampling design was used to obtain representative samples of AMI patients in western rural hospitals from 1,6 and 2011. The weighted use rate and trend of aspirin in patient-level at the early stage of hospitalization in 3 years were analyzed to represent the overall situation of AMI inpatients in western rural areas. When the use rate of aspirin in hospital-level was analyzed, the hospitals with less than 5 enrolled cases were excluded, so as to reflect the overall level of western rural hospital. Logistic regression analysis was used to analyze the related factors affecting aspirin use. Results A total of 1006 AMI patients from 32 western rural hospitals were enrolled in this study. The median age of the patients was 66 years old, and the proportion of women was 26.9%. From 2001 to 2011, early weighted use rate of aspirin was significantly improved (69.9% in 1,4.9% in 2006 and 88.8% in 2011, and trend P value＜0.0001). From the hospital-level, the rate of early aspirin medication also showed an increasing trend year by year.However, even in 2011, there were still 2 hospitals (about 10%) with early aspirin use rate of less than 80% (55.6% and 69.2% respectively). Multivariate Logistic analysis showed that patients with chest discomfort at admission (OR 4.6,5%CI 2.7-7.8) and PCI capacity hospitals (OR 3.2,5%CI 1.5-6.7) were more inclined to use aspirin, and non-ST-segment elevation myocardial infarction patients were less likely to use aspirin (OR 0.5,5%CI 0.3-0.8). Conclusion From 2001 to 2011, the use rate of early aspirin in AMI hospitalized patients in rural areas of western China shows an obvious upward trend, but some hospitals and some characteristic populations still have a lot of room for improvement.