Early revascularization with primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) has been shown to reduce mortality, rates of nonfatal reinfarction and stroke, as compared to previous standard of care with thrombolytic therapy. Despite substantial evidence of its effectiveness, the use of PPCI varies considerably across Europe. The Stent for Life Initiative supports implementation of local STEMI treatment guidelines, helps to identify specific barriers to implementation of guidelines and defines actions to make sure that the majority of STEMI patients have access to PPCI. Launching a successful programme for PPCI requires the commitment and collaboration of a broad variety of members of the healthcare system. This narrative review is intended to describe some of the progress already seen in the 10 countries currently included in the Stent for Life Initiative and to report and discuss the engagement of the various stakeholders involved.