Aims: Anxiety has been increasingly identified as a cardiac risk factor. However, less is known about the impact of anxiety on prehospital delay during an acute myocardial infarction (AMI). This study assessed the impact of anxiety on prehospital delay and delay related cognition and behaviour. Methods: Data were from the cross-sectional Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study with a total of 619 ST-elevated myocardial infarction (STEMI) patients. Data on sociodemographic, clinical and psycho-behavioural characteristics were collected at bedside. The outcome was assessed with German version of Generalized Anxiety Disorder scale (GAD-7). A GAD-7 score greater than or equal to 10 indicates general anxiety disorder. Results: A total of 71 (11.47%) MI patients suffered from GAD. During 6 months prior to MI, patients with GAD were more likely to perceive a higher cardiovascular risk (OR: 0.39, 95%CI 0.21-0.73) and to suffer from dyspnoea (p = 0.04) and sweating (p = 0.03). In the acute phase, patients with GAD were more likely to experience fear of death (p = 0.001) but made more self-decisions to go to hospital (OR: 2.68, 95%CI 1.48-4.85). GAD was associated with decreased odds of delaying more than 2 hours (OR: 0.58, 95%CI 0.35-0.96). However, GAD was also highly associated with impaired psychological well-being, perceived stress and fatigue (p < 0.0001). Conclusions: In AMI patients, GAD was associated with less prehospital delay, but led to an impaired psychological state.