Background: Information is limited concerning how the affected individuals interpret and respond to the early warning signs before their acute coronary event, and how the presence of prodromal symptoms impacts on pre-hospital delay. Objectives: To identify the characteristics and interpretation of prodromal symptoms in the patients with a first-time acute myocardial infarction (AMI), and to determine whether the presence of prodromal symptoms was predictive of pre-hospital delay. Methods: A total of 271 hospitalized patients diagnosed with AMI were interviewed individually from November 2007 to December 2008 at C University hospital in G-city, Korea. Patients were queried regarding a major unusual prodromal symptom. Results: The 53% and 54.2% of male and female patients had experienced prodromal symptoms, respectively, in the week or in three months prior to the acute cardiac event. The affected patients were more likely to be older and to have no chest pain upon hospitalization than those with no prodromes. There was no significant gender difference in the prevalence of prodromes. Many patients did not recognize the importance of their warning symptoms and about 40% visited a clinic in response to any prodromal symptom. Logistic regression analyses revealed that the presence of prodromal symptoms was an independent predictor affecting pre-hospital delay time. Conclusions: Recognizing their prodromal symptoms may be one effective way for patients to seek medical help earlier and educational strategies should focus on improving awareness of early prodromal symptoms of AMI, particularly those with a family history or at high risk for cardiovascular disease. Prospective longitudinal studies are needed to clarify the impact of the prodromal symptoms on clinical outcomes for Korean AMI patients.