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Fibrinolytic therapy is a time critical intervention proven to reduce mortality and morbidity in patients with acute ST elevation myocardial infarction (STEMI). Limited data exists in South Africa regarding time to fibrinolytic therapy for STEMI patients and reasons for delayed therapy. We established the frequency of fibrinolytic therapy administration to patients presenting with STEMI to a single, urban center in Pretoria, South Africa. Furthermore, we identified reasons for delays in receiving fibrinolytic agents. We suggest potential solutions to address the myriad of challenges facing our country in this regard.