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The No.1 seed beat Medvedev 6-2 5-7 6-4 in a semi-final that was suspended on Saturday (AEST) because of heavy rain, with Sinner leading 4-2 in the decider when play was halted.

Sinner will play Norwegian Casper Ruud, the No.23 seed, who has lost four times against the Italian.

"A tough challenge, to be honest. During the night, usually I never struggle to sleep. This night was not easy," Sinner said.

"When you're in the third set, nearly done, but you still have to show up again ... It's basically a new start of a match. There are nerves again, but I'm very happy how I handled the situation."

The victory extended Sinner's remarkable Masters winning streak to 33 consecutive matches, a record run that has seen him claim titles in Paris, Indian Wells, Miami, Monte Carlo and Madrid.

Remarkably, the Rome crown is the only one missing from his impressive Masters collection, having lost to Carlos Alcaraz in last year's final.

By reaching the showpiece, Sinner also became the first Italian since Nicola Pietrangeli 68 years ago to reach back-to-back Rome finals.

Sinner has a perfect 4-0 record against Ruud, including a quarter-final win in Rome last year, and has never dropped a set against the Norwegian. But he expects a stern test.

"I think he's playing much, much better tennis right now, it's going to be very tough," Sinner added.

"I'm just happy to stand again here in the final - special tournament for me, special tournament for Italians ... If it goes well, I'm very happy. If not, the final of a Masters is an amazing result."