ABSTRACT
Background: Timely reperfusion is the cornerstone of ST-elevation myocardial infarction (STEMI) management. Despite major advances in primary percutaneous coronary intervention (PCI), substantial delays persist, particularly in Eastern Europe. Methods: We conducted a retrospective, registry-based analysis of 151 consecutive patients with STEMI admitted to a tertiary emergency university hospital in Romania between April and October 2025. Demographic characteristics, cardiovascular risk factors, reperfusion timelines, and in-hospital outcomes were analyzed. Results: Mean total ischemic time was 421 min, driven predominantly by prolonged pain-to-call (229 min) and first medical contact (FMC)-to-door (102 min) intervals. In-hospital door-to-balloon times were largely compliant with European Society of Cardiology recommendations. In-hospital mortality was 8.94%. Conclusions: STEMI care in Romania is characterized by significant pre-hospital delays despite efficient in-hospital workflows. Targeted public education, optimization of emergency medical service pathways, and broader implementation of pharmaco-invasive strategies may substantially reduce ischemic time and improve outcomes.