Differences in utilization of health care services and the quality of those services between geographic regions of the United States exist. Public policy, guidelines, and health care organizations have attempted to address these differences. In 1992 the Healthcare Financing Administration, now the Center for Medicare/Medicaid Services (CMS), initiated the Cooperative Cardiovascular Project with the goal of improving the quality of care for acute myocardial infarction (AMI) nationally. Standards were developed for the evaluation of quality care based on the guidelines of the American College of Cardiology and the American Heart Association. The initial results from this national survey of AMI quality care was presented in 1998 and a follow-up survey reported in 2003. National performance since 1999 has been evaluated primarily on the basis of data from voluntary reporting systems, such as the National Registry of Myocardial Infarction, The National Cardiovascular Data Registry, the CMS and Hospital Quality Alliance Program (begun in 2004), and the American Heart Association’s Get With The Guidelines coronary artery disease program. There have been efforts to use these programs and quality measures to determine the role they play in the known cardiovascular disease disparities among minority populations. Cardiovascular disease accounts for a large proportion of morbidity and mortality among American Indians. Yet, studies of cardiovascular disease quality of care among American Indians are limited. The Strong Heart Study is a longitudinal cohort study of cardiovascular disease and its risk factors in American Indians. It is the longest-running population-based cohort study among American Indians with centers in three primarily rural geographic regions in the United States. It has rich demographic and clinical data including physician adjudicated cardiovascular events. In this study, we describe AMI quality care measures from the Strong Heart Study and then compare them to previously published studies from CMS.