Background: Acute myocardial infarction (AMI) is a life-threatening and highly time-sensitive emergency. Management is initially based on the use of the emergency medical service (EMS) system by patients. We aimed to identify individual (sociodemographic and clinical), contextual (socio-economic level of place of residence), organisational (healthcare services) and structural (hospital facilities) factors associated with the primary healthcare use for patients with AMI. Methods: The factors were identified in two steps: 1) construction of a healthcare utilization conceptual model focused on AMI using a scoping review; 2) assessment of the association between individual and collective factors and healthcare utilization of AMI patients included in a French regional registry between 1st January and 31st December 2019, before the Covid-19 pandemic. The statistical model was a multivariate logistic multinomial mixed model with a random effect on health territory. The variable to explain was the effective use of care in three modalities: mobile intensive care units (MICU) after EMS-calling (optimal pathway), direct arrival in the emergency unit after EMS-calling, direct arrival in the emergency unit without EMS-calling. Results: Among the 1665 patients included, 54% were managed by MICU and 19% arrived at the emergency unit after EMS-calling. Factors associated with direct arrival at the emergency unit after EMS-calling were advanced age (OR=1.15 - p=0.015), being a woman (OR=1.85 - p<0.001), history of coronary heart disease (OR=0.57 - p=0.006) and presence of a cathlab in the hospital (OR=1.44 - p=0.020). Rurality of residence was associated with direct arrival at the emergency unit without EMS-calling (most rural level: OR=3.43 – p=0.005). Conclusions: This study has made it possible to identify AMI populations outside the optimal access to care pathway. Awareness-raising actions are needed in the general population and among emergency health professionals in order to reduce age or gender inequalities and territorial inequalities in care.