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Introduction ST-elevation myocardial infarction (STEMI) is a major cause of mortality and morbidity.Timely reperfusion therapy is a key determinant of outcome.Thus, there exist guidelines for how quickly primary percutaneous intervention (PPCI) should be performed.However, those targets are not always met, due to a variety of contributing factors.We aim to shed light on what may lead to the times being breached, in order to then design evidence-based ways to improve practice.Methods We analysed every PPCI performed at a major UK cardiac centre in 2022 (n=158) and 2023 (n=202).We audited the procedures against European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE, UK) guidelines for call-to-balloon (CTB) and door-to-balloon (DTB) times.We used independent-samples t-tests and Fisher's exact tests to examine hypothesis-driven patient characteristics that may predict breaches. These included age, road distance, diabetes, hypertension, hyperlipidaemia and smoking status.We wrote our own software to visualise the geographical distribution vs. performance.We used a stringent p-value correction (Bonferroni) for multiple testing.Results The findings for the 2 calendar years were consistent.Road distance did not statistically significantly influence breaches (p=0.23).Older age was a significant factor for CTB breaches (p=0.008).Self-presentation led to breaching DTB (p < 0.00001).Conclusions Since road distance was not significantly associated with breaches, the bottleneck must lie elsewhere.Older people may be more difficult to extricate, convey and treat. This could be because they are less mobile.Patients are better off arriving in an ambulance, because that skips the emergency department.It could be beneficial to have a streamlined pathway for self-presenters to be taken to the catheter lab more quickly.