BACKGROUND:Despite the effectiveness of timely reperfusion therapy for acute coronary syndrome, prehospital delay remains a global concern. OBJECTIVE:This article assesses the state-of-the-science regarding prehospital delay for acute coronary syndrome in China. METHOD:Electronic databases and hand searching were undertaken using key words such as prehospital delay, care-seeking delay, coronary heart disease, heart disease, acute coronary syndrome, unstable angina pain, acute myocardial infarction, cardiovascular disease, chest pain, and Chin (China/Chinese). The Chinese search was supervised by a Chinese health librarian. RESULTS:Based on the search criteria, 28 studies were identified and reviewed using a standardized data extraction tool. Older age, attribution of symptoms to noncardiac causes, lack of health insurance coverage, poor access to transportation, and female sex were identified as contributing to prehospital delay. CONCLUSION:Health system reforms in China are necessary, particularly with regard to addressing the needs of older people, women, and other vulnerable populations in the context of the rising number of people with coronary heart disease. Developing targeted strategies, learned from both national and international experience, are required to develop targeted interventions.