Delay in initiation of reperfusion therapy (thrombolysis or primary Percutaneous Coronary Intervention) has been shown to be the detrimental factor of worsened outcome from ST elevated acute myocardia infarction. The data on the actual delay in initiation of reperfusion therapy in India is sparse. This study was designed to assess the various factors responsible for the delays in starting reperfusion therapy in patients presenting with ST elevated acute myocardial infarction. The results of this study indicate that a large portion of the delay was prehospital delay from the onset of angina pain to patient visiting the hospital. Factors responsible for this delay, which are totally preventable, were difficulty in arranging transport, lack of patient education and late recognition of symptom or its severity. This study also noted that there was a significant delay in hospital-door to ECG and hospital-door to thrombolytic or balloon angioplasty as well. Understandably, higher literacy level in urban patients (78.6%) played a major role in urban patients coming to hospital for treatment more than their rural counterparts.