Rapid medical intervention is essential to the successful treatment of patients suffering from acute coronary syndromes (ACS) because of the need for prompt thrombolysis and measures to reduce risk of fatal arrhythmias [1]. Although it has been known for more than 20 years that delays between symptom onset and treatment of less than 60 min are desirable [2], pre-hospital delays remain unacceptably long, with median intervals averaging 2 to 4 h [3–6], while interventions to reduce delays have met with limited success [7]. A greater understanding of the contributing factors may stimulate new approaches to reducing delays. A number of sociodemographic, clinical, social and proximal factors have been associated with pre-hospital delay [1,4,6,8–11]. The total pre-hospital delay period consists of two components: time taken by patients to recognise recognize that their symptoms are serious and to contact medical help (decision time) and the time taken from requesting help to hospital admission (home-to-hospital delay). Different factors may affect these 2 components [12] so we carried out a study of factors associated with total pre-hospital delay and its components. Most previous studies have focused on one or two specific areas, but this study investigated a range of sociodemographic, clinical, social and proximal factors simultaneously in the same sample. We set out to discover what are the characteristics of patients who have long pre-hospital delays, and what factors are specifically associated with the two components: decision time and home-to-hospital delay. Previous research also suggests that consultation with a physician or family member may lead to longer pre-hospital delays in comparison with direct contact with emergency medical services (EMS) [1,13]. Additional analyses of factors associated with contacting the EMS were therefore conducted.