years since 1979, where almost all AMI patients in the Miyagi Prefecture have been prospectively registered. [18][19][20] In a previous report, we demonstrated the trend for increasing incidence and decreasing in-hospital mortality of AMI from 1979 Since then, we have been facing rapid social aging in Japan, where such aging should affect the actual situation of cardiovascular diseases, including AMI. Thus, in the present study, we examined the temporal age-specific trends in the incidence and inhospital mortality of AMI during the past 30 years (from 1985 to 2014) in our Miyagi AMI Registry. MethodsThe present study was approved by the Institutional Review Board of Tohoku University Graduate School of Medicine A cute myocardial infarction (AMI) is a leading cause of death and a serious public health problem worldwide, especially in developed countries. 1-3 In Western countries, decreasing trends in the incidence and mortality of AMI have been reported since the 1980 s, 4-8 in association with public efforts to reduce coronary risk factors and improved critical care for AMI (e.g., reperfusion therapies). 9-11 In contrast, in Asian countries, including Japan, Taiwan and Korea, AMI has become more common because of prolonged life expectancy, rapid socioeconomic advances, and westernization of life style and diet. 12, 13 In Japan, there have been a few registry studies of AMI and most of them included a relatively small number of patients and/or a relatively short study period. 14-17 In order to elucidate the accurate trend of AMI in Japan, we have been conducting the Miyagi AMI Registry Study for 37 Background: We are now facing rapid population aging in Japan, which will affect the actual situation of cardiovascular diseases. However, age-specific trends in the incidence and mortality of acute myocardial infarction (AMI) in Japan remain to be elucidated.

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Background: We have previously demonstrated the trends for increasing incidence of acute myocardial infarction (AMI) and decreasing incidence of in-hospital mortality in Japan between the late 1970s and 2000s. However, the temporal trends in incidence and mortality of AMI in the 21st century in Japan remain to be elucidated since the previous report. Methods and Results: Miyagi AMI Registry Study is a prospective and observational study where all AMI patients in the Miyagi prefecture (2.32 million populations) have been registered. In the present study, we divided a total of 27,220 AMI patients (male/female 19,818/7,402) into 4 age groups (≤59, 60-69, 70-79 and ≥80 years) by sex, and examined decennial trends during the last 30 years (1985-1994, 1995-2004 and 2005-2014) in terms of incidence and in-hospital mortality of AMI. Statistical analysis was performed by using the piecewise linear regression model. In patients aged ≤59 years of both sexes, increasing trend in the incidence of AMI was consistently noted throughout the last 30 years (P<0.01 in both sexes), whereas in male patients aged 60-69 years, the incidence of AMI was unaltered during the study period (P=0.11). On the other hand, in the remaining groups, including males aged 70-79 and ≥80 years and females aged 60-69, 70-79 or ≥80 years, the incidence of AMI showed a significant trend of decrease in the last decade (P<0.01 in all groups) (Figure). In-hospital cardiac mortality was also significantly decreased during 1985-1994 in all age groups in both sexes (P<0.01 in all groups), whereas in the last two decades, no such trend of in-hospital cardiac mortality was noted irrespective of sex or age. Conclusions: These results indicate the temporal trends in incidence of AMI in Japan, including the increases in younger ages and the decreases in elderly ages, providing a clue to further improve emergent care for AMI.

Background: In the current primary percutaneous coronary intervention (PCI) era, some patients in acute myocardial infarction (AMI) still do not undergo primary PCI in Japan. We thus aimed to elucidate the characteristics of AMI patients who did not receive primary PCI. Methods and Results: We analyzed the patients enrolled between 2002 and 2010 in the Miyagi-AMI Registry Study, where all AMI patients in the Miyagi prefecture have been prospectively registered for 34 years since 1979. Among a total of 8,640 patients with AMI (M/F 6205/2435, mean age 68.9±13.0 [SD] years), 1,879 (21.7%) did not receive primary PCI and their in-hospital mortality was significantly worse compared with those who received it (21.4% vs. 6.4%, P<0.01). Multivariate analysis demonstrated that female sex was significantly associated with non-performance of primary PCI [odds ratio (95% confidence intervals); 1.40(1.22-1.61), P<0.001], along with aging [1.01(1.01-1.02), P<0.001] and heart failure on admission [2.69(2.29-3.16), P<0.001]. When dividing by age, non-performance rate of primary PCI in female showed U-shaped prevalence, whereas it simply increased with aging in male (Figure A) . Importantly, female patients aged <80 years had a significantly higher non-performance rate of primary PCI compared with male patients, regardless of disease severity as evidenced by co-existing heart failure on admission (Figure B) . Conclusions: These results indicate that in the current PCI era, various factors, including aging, heart failure on admission and sex differences, are associated with non-performance of primary PCI, which remain to be resolved in order to further improve critical care of AMI.