Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial
infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45% of European STEMI patients are currently treated with PPCI
and there are large differences in this proportion between different European countries. Several studies have emphasised that PPCI delivery
is complex, with multiple potential barriers to implementation, but there is no comprehensive research estimating the significant
characteristics, factors and structures that determine the diffusion of PPCI in Europe. The lack of complete implementation and large national
and regional differences arise from the interplay between technology, patients, policy makers, culture and resources. Explanations for the
variation in treatment access still remain a puzzle and access to valid data is needed.

Keywords
Primary percutaneous coronary intervention, acute ST-elevation myocardial infarction, implementation, practice variation, registry data