The increasing burden of cardiovascular disease in India, and the established efficacy of mortality-reducing therapies in acute myocardial infarction (AMI) served as the impetus to compare the management practices of AMI in an Indian hospital and a similar hospital in Canada. A retrospective chart review in each hospital was conducted to identify differences in risk factors, presentation, and acute in-hospital management in patients with AMI. Indian patients were younger (47 +/- 9 years versus 54 +/- 8 years), more likely to have a history of diabetes (21/87 versus 6/69) and less likely to have a previous history of angina (5/87 versus 22/69) compared to Canadian patients (all p < 0.001). The delay from symptom onset to hospital arrival was greater in Bangalore, India (median time 330 min versus 101 min, p < 0.001), yet the in-hospital delay in receiving thrombolytic therapy was greater in Hamilton, Canada (70.5 min in Hamilton versus 30 min in Bangalore, p < 0.0001). There was similarity and appropriate use of thrombolytic therapy, aspirin, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in both centres. The pattern of presentation and risk factors differ in Indian and Canadian patients. However, once patients present, the patterns of practice appear to be similar.