Drawing on the morphogenetic approach proposed by Archer (1995), this study explains how the Stent for Life (SFL) initiative emerged and developed in Portugal and how it was embraced as a means to reduce mortality following acute myocardial infarction. A qualitative research strategy based upon a case study was adopted. Only by conducting qualitative research was it possible to interact context with explanation and produce understandings for the "who", "when", "why", "how " and "what" of SFL in Portugal (Mason, 2018;Ackroyd and Karlsson, 2014;Yin, 2015). Archer's morphogenetic approach makes analytical dualism explicit and therefore very useful in accounting for the existence of prior material structures and cultural structures that affected (but did not determine) agents' actions. The investigation revealed that there was morphogenesis (i.e. the former structures were transformed) and that new structures emerged from the intended consequences of agents' activities.Keywords -Stent For Life in Portugal; Archer's morphogenetic approach; Critical realism; ST-segment elevation myocardial infarction. constitutive, precluding any examination of their interplay and of the effects of one upon the other. 2 This refers to time between presentation at the PPCI hospital (i.e., a hospital with PPCI facilities) and use of first device in the culprit artery (Pereira et al., 2014).3 That is the official annual meeting of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). 4 The number of countries involved in the SFL increased to nine at the end of 2010, after Egypt, Italy, and Romania decided to adhere to the SFL. Furthermore, in 2012 Bosnia and Herzegovina and Ukraine joined the initiative; also, in 2013 Cyprus decided to become involved in the SFL. 5 Patient delay is defined as the time between symptom onset and first medical contact (FMC) (Pereira et al., 2014). 6 The Manchester screening system was implemented in Portuguese hospitals at the beginning of the 2000s and aims to classify the severity of patients in emergency services. 7 APIC is a professional association of the Portuguese Society of Cardiology that aims to study and promote scientific activities related to medical, surgical, technological, and organisational aspects of cardiovascular intervention. Dr. Pereira became its general secretary and later, in 2012, its president. 8 The organisation of the Portuguese health system is based upon the division of the country into five regions (Lisbon and Tagus Valley, North, Centre, Alentejo and Algarve). 9 The national public campaign of "Act now. Save a Life" developed by Dr. Pereira received over two hours of coverage on three national television channels in eight months.
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