Coronary artery disease remains a significant health problem, especially in developing countries. Adherence to guideline-directed therapy improves the quality of care. In this study we assessed adherence to quality indicators (QIs) for ST-elevation myocardial infarction (STEMI) management in our center as an example from a developing country. Our study included 870 STEMI patients who were admitted to our center (Assiut University Heart Hospital, Egypt) and eligible for primary percutaneous coronary intervention during the period from January 2022 to December 2022. Fifteen QIs were studied. The results show that our center is closely adherent to STEMI management guidelines. However, the most important gaps were related to time delays. The mean of first medical contact (FMC) to electrocardiogram (ECG) time was 13.2 ± 16.1 minutes and arrival time to ECG time was 12.8 ± 3.9 minutes. The mean of FMC to device time for total patients was 61.2 ± 42.8 minutes. However, that for patients transferred from non-PCI capable center was 108.2 ± 63.5 minutes compared to patients presented directly to our center (mean arrival time to a device was around Mean 49.6 ± 22.5 minutes). This resulted in only 77% of patients having FMC to device time < 90 minutes. Regarding guideline-directed medical therapy, we are adherent by more than 90%. In-hospital mortality was 1.1%. So we conclued that many centers in developing countries are closely adherent to QIs of STEMI management. However, there are still some limitations including delays in transportation, a limited number of primary PCI centers, absence of a well-established network of communication between centers, and financial issues.