Off-hours presentation resulted in a significant increase in the onset of pain to balloon inflation time (approximately 1.3 hours) as well as the emergency room to balloon inflation time (approximately 54 minutes). However, this delay to reperfusion did not result in a difference in clinical outcomes (in-hospital or long-term) in patients undergoing direct percutaneous transluminal coronary angioplasty within 12 hours of the onset of acute myocardial infarction.