Purpose: Time is crucial in the management of acute ST elevation myocardial infarction (STEMI). Delays in presentation and treatment reduce the efficacy of reperfusion therapy and the chance of myocardial salvage. The delay varies widely across different countries because of different patients' profile and different healthcare capabilities. The pre-hospital delay, hospital delay and total ischemic time have not been reported in Egyptian tertiary care facilities.Methods: From August 2013 to April 2014, we included all patients with STEMI who presented within 24 hours of symptom onset. We recorded the time between the onset of acute severe symptoms and arrival to the hospital (pre-hospital delay). We categorized pre-hospital delay as either patient-related (time passed before patients decided to go to hospital) or transportation-related. We also recorded the time between arrival to hospital and the institution of reperfusion therapy -thrombolysis or primary PCI- (hospital delay). We categorized hospital delay causes as staff-related (lack of trained personnel or physician inertia) or system-related (shortage of beds or consumables).Results: We recruited 81 patients, 53 (65.4%) were males, 48 (59.3%) had hypertension, 43 (53.1%) had diabetes, 37 (45.7%) were smokers and 32 (39.5%) had prior history of cardiac diseases. Twenty-three patients (28.4%) had primary PCI and 58 patients (71.6%) received thrombolytic therapy. The mean pre-hospital delay was 5.0±3.0 hours. 44% of that time was patient-related and 56% was spent in transportation. Only 2 (2.5%) patients used an ambulance, the rest of patients used their private cars (43.2%), taxi (43.2%) or public buses (11.1%). The mean door to needle time was 94.1±31.8 minutes while the mean door to balloon time was 153.2±39.4 minutes. 31% of hospital delay was system-related while 53% was staff-related. The mean total ischemic time was 6.5±3.3 hours for thrombolysis and 7.8±2.7 for PCI.Conclusion: The delay is considerably longer than that reported in literature. The priority to improve pre-hospital delay should be given to facilitate transportation through ambulances. Efforts to shorten hospital delay should focus on better bed management and more supply of consumables