OBJECTIVES: The incidence of acute coronary syndrome (ACS) in the Czech Republic is 3248 cases/million/year (CZECH registry) and belongs to the most frequent causes of hospitalizations. The aim was to assess and compare costs and length-of-stay in patients with STEMI and non-STEMI in the Faculty Hospital in the Czech Republic from payer’s perspective. METHODS: Retrospectively tracked data were clinical characteristics, medication, stay in standard cardiology unit (SCU) and/or intensive care unit (ICU) and revascularisation procedures in patients hospitalized with STEMI or non-STEMI in specialized centre for patients with ACS. In-patient care costs include flat rate of admission, examinations, stay in monitored bed, drugs and particularly coronary angiography and percutaneous coronary intervention (PCI) (25.5CZK = 1EUR). RESULTS: Total 385 patients (mean age 63.9 years; 75.6 % male; 61 % hypertensive) were evaluated, 54.5 % of patients with STEMI and 45.5 % of patients with non-STEMI. 15.1 % of patients had MI in anamnesis and 9 % of patients were treated previously PCI. The coronary angiography was performed during hospitalization in 95 % of patients; revascularisation by PCI with stent implantation was in 71.9 % of patients (86.2 % STEMI and 54.9 % non-STEMI; p<0.001); 10.9 % were treated by coronary-artery bypass (5.2 % STEMI and 17.7 % non-STEMI; p<0.001). The mean length-of-stay was 5.7 days (5.9 days STEMI and 5.5 days non-STEMI; p=0.033) with mean total cost €3597.5 (€4288.7 STEMI and €2768.0 non-STEMI; p<0.001). 77.1 % of patients were in need of ICU on an average 2.3 days. The mean rate of PCI was €3380. CONCLUSIONS: Acute coronary syndromes present substantial medical, social, and economic burden worldwide in particular due to high prevalence and expensive treatment procedures. In our study the cost of PCI formed around 85 % of a total in-patient cost in both STEMI and non-STEMI.