To examine the particular features that characterized patients who arrived in the hospital relatively early compared to those who arrived relatively late after the onset of cardiac symptoms.A sample of 6 hospitals located in Greek urban and rural regions was selected. In these hospitals we recorded almost all non-fatal admissions with first event an acute coronary syndrome, from October 2003 to September 2004. 2172 patients were included in the study (76% men, 24% women). The time delay from symptom onset to hospitalization was recorded. Socio-demographic, clinical, dietary and other lifestyle characteristics were also recorded.The overall median (25th, 75th percentiles) delay time was 3.5 (2, 8) h. Patients with a history of hypertension or diabetes mellitus, as well as those receiving diuretics and calcium antagonists, were more likely to seek medical care more than 6 h after the onset of symptoms. Patients who died in hospital had sought medical care later than those who survived (p = 0.008). Moreover, the administration of thrombolytic therapy was inversely related with the time interval between the onset of symptoms and presentation to hospital. Median (25th, 75th percentiles) delay time was 2 (1, 4) h for patients who received such therapy and 4 (2, 11) h for those who did not (p < 0.001).Our findings indicate the need for developing community-wide educational approaches to reduce delay.