Background: Acute coronary syndrome (ACS) encompasses a spectrum of conditions, including ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. It is a critical manifestation of coronary heart disease (CHD), a leading cause of mortality worldwide, accounting for one-third of deaths in individuals over 35 years of age. Unlike other forms of CHD that may be asymptomatic, ACS always presents with symptoms. This study aims to identify the factors contributing to delays in seeking treatment for ACS, a critical issue impacting patient outcomes. The objective was to identify the factors associated with delays in seeking treatment for acute coronary syndrome. Methodology: The cross-sectional study was conducted at Department of Cardiology, MTI-Mardan Medical Complex, Mardan from 10 December 2021 to 10 June 2022. Patients diagnosed with ACS were thoroughly evaluated using standard clinical protocols. Factors contributing to delays in seeking treatment were recorded, including demographic, social, and clinical variables. Data was entered and analyzed using SPSS version 23.0. Post-stratification chi-square tests were applied, keeping P-Value ≤ 0.05 as significant Results: The study identified several key factors contributing to treatment delays. Increased age accounted for 25.1% (64 patients) of the delays, while being a single woman contributed to 18.0% (46 patients). Additionally, 24.3% (62 patients) delayed treatment while waiting for symptom improvement, and 32.5% (83 patients) attributed delays to low levels of educational awareness. Conclusion: This study highlights significant pre-hospital delays in ACS patients, primarily due to low educational awareness, increased age, and waiting for symptoms to improve. Addressing these factors through public education and better access to healthcare can reduce delays and improve patient outcomes.