OBJECTIVES: ST-segment elevation myocardial infarction (STEMI) is a leading cause of global morbidity and mortality, comprising 25-40% of MI presentations, with varying outcomes. 5-6% of patients die before leaving hospital, and 7-18% of discharged patients die within one year.  In Romania, the annual mortality rate is 14.5% for admitted patients. An Excel-based model was developed to assess the clinical and economic impact of different treatment strategies for STEMI patients in Romania. METHODS: This model uses data from the Romanian National Registry, Romanian Heart Foundation, and CC Iliescu Heart Institute to evaluate STEMI treatment scenarios based on disease awareness, timely hospital admissions, and treatment with PCI, versus alternative approaches such as thrombolytics or no reperfusion. 2009-2014 outcomes were modeled year-over-year for sequential STEMI cohorts. Prospective outcomes through 2019 were modeled to calculate the value of continued investment in STEMI management. Model inputs included morbidity and mortality, labor productivity (measured by average wage), direct treatment costs, and disease burden (measured by disability-adjusted life-years and value of a statistical life).  Outputs were calculated up to one year after initial STEMI event, and calculated separately for hospital-admitted and non-admitted populations, with the latter group divided by treatment pathway: PCI, thrombolytics, no reperfusion, or CABG. RESULTS: From 2009-2014, an investment of 20.8 million € in interventional cardiology and catheterization laboratories resulted in 2,197 lives saved, with cost savings of 21.6 million € from improved productivity. Prospective calculations through 2019 show an investment of 14.2 million € would result in 1,528 lives saved, with cost savings of 12.3 million €.   CONCLUSIONS: From 2009-2014, Romanian healthcare expenditures to improve STEMI management strategies showed favorable clinical outcomes when more patients were managed with PCI. This mortality reduction suggests that continued national investment in STEMI management could further improve these rates, with greater cost savings achieved as a result.