Introduction: Cardiovascular disease represents the major cause of mortality in the modern world, Romania having one of the highest rates in Europe. Acute myocardial infarction is one of the most important causes of cardiac death. The golden standard of treatment for STEMI is primary PCI. The main goals of primary PCI network are to minimize delay between first medical contact, diagnosis of STEMI and early myocardial reperfusion through primary PCI (door-to-balloon time). The national Romanian network began operating in August 2010, 10 PCI-capable hospitals being initially involved, with 14 centers at present time, covering all country regions in a 24/7 system of service. Methods: All centers report their activity monthly as numbers of procedures and also fill in the RO-STEMI Registry. During 44 months there were reported 19,276 coronary angiograms and 16,551 PCI. Today ROSTEMI Registry contains 14,488 records. The number of STEMI patients who were referred to a primary PCIcapable center had steadily increased, from about 4,000 coronary angiograms performed in the first year, to almost 5,500 in the second, and less than 6,000 in the third year (a 44,4% increase in second year compared to the first, and 50% in the third year). 86% of these patients received PCI. Results: A mean of 438 coronary angiograms were performed every month, nationwide, from august 2010 to present. Because of the low number of primary PCI centers serving relatively large regions, as expected, a few hospitals reported a high volume of patients. The sharp 35.4% increasing in the number of STEMI patients who were referred for primary PCI in the second year compared to the first reflects the increasing awareness of physicians in non-PCI capable centers of the importance of timely reperfusion in STEMI, leading to an overall in-hospital global mortality dropping from 13% in 2010 to about 8 % in 2013. In PCI’s centers mortality was under 4%, probably due, among other variables, to operator experience. These dates are similarly to those reported in Western countries Conclusions: The benefits of the National Program for Early Invasive Treatment of Patients presenting with STEMI in Romania are obvious, with a clear impact on in hospital mortality, reassuring and encouraging the medical and non-medical personnel to continue the efforts of maintaining and developing this program. Future steps should to be taken to fully accomplish the goals of this initiative (e.g. increase the use of primary PCI to more than 70% of STEMI patients, achieve PCI rates of more than 600 per 1 million inhabitants per year) and to reduce the door-to-balloon time, mainly by expanding the STEMI network through the inauguration of new primary PCI capable centers and proficient training of interventional cardiologists.