Japanese Acute Myocardial Infarction Registry

Japanese Acute Myocardial Infarction Registry
Name	Japanese Acute Myocardial Infarction Registry
Established	1990s
Country	Japan
Focus	Acute myocardial infarction, cardiology, outcomes research
Sponsors	Japanese Circulation Society, academic institutions, hospitals

Japanese Acute Myocardial Infarction Registry

The Japanese Acute Myocardial Infarction Registry (JAMIR) is a nationwide clinical registry that collects detailed patient-level data on acute myocardial infarction across Japan, supporting research, quality improvement, and guideline development. It links clinical care sites with academic centers and professional societies to monitor treatment patterns, procedural outcomes, and long-term prognosis in patients presenting with ST-elevation myocardial infarction and non–ST-elevation myocardial infarction. The registry has informed practice guidelines, influenced national quality metrics, and served as a platform for observational studies and randomized registry trials.

Overview

JAMIR aggregates inpatient and follow-up data from tertiary hospitals, community hospitals, and ambulatory networks to characterize real-world management of myocardial infarction, integrating procedural details, pharmacotherapy, laboratory values, and mortality outcomes. The registry interfaces with institutional review boards at major universities, cardiology departments within teaching hospitals, and national specialty organizations to ensure data governance and clinical relevance. It complements administrative databases, electronic health records from hospitals, and imaging repositories used by interventional cardiology units and emergency medicine services.

History and Development

The registry emerged amid a wave of cardiovascular surveillance initiatives in the 1990s and 2000s when professional bodies and academic centers prioritized outcome measurement after landmark trials reshaped acute coronary syndrome care. Early collaborators included leading cardiology divisions at major universities and regional cardiovascular centers, aligning registry methods with international registries developed in Europe and North America. Over time, JAMIR expanded through partnerships with professional societies and hospital networks, adopting standardized case definitions and data dictionaries similar to those employed by registries overseen by prominent organizations and academic consortia.

Objectives and Governance

Primary objectives include benchmarking care quality, monitoring adherence to guideline-directed therapies recommended by national and international guideline committees, and facilitating clinical research by providing a high-quality observational dataset. Governance typically involves a steering committee composed of representatives from academic medical centers, professional societies, and hospital systems, with data management performed by clinical research organizations and academic cores at leading universities. Ethical oversight is provided through institutional review boards and data use agreements aligned with national regulatory frameworks and ethical standards promoted by professional associations.

Data Collection and Methodology

Data collection uses standardized case report forms and electronic data capture systems to record demographics, symptom onset, electrocardiogram findings, angiographic results, reperfusion strategies including percutaneous coronary intervention and thrombolysis, adjunctive pharmacotherapy, and in-hospital adverse events. Follow-up protocols capture mortality, readmission, and functional status at prespecified intervals, with adjudication committees to validate clinical endpoints through source document review. Methodological features include risk-adjustment models using variables drawn from clinical trials and epidemiologic studies, statistical analysis plans developed by biostatisticians at major academic centers, and quality control measures such as onsite monitoring and data audits.

Findings and Impact on Clinical Practice

Analyses from the registry have documented temporal trends in reperfusion timing, door-to-balloon performance, use of primary percutaneous coronary intervention, and adoption of modern antiplatelet regimens, influencing guideline revisions and performance measures recommended by national specialty societies. Findings have highlighted differences in outcomes by age, comorbidity, and geographic region, prompting targeted quality improvement initiatives at regional medical centers and teaching hospitals. Registry-derived evidence contributed to national statements and consensus documents from professional associations and helped harmonize practice with evidence from landmark randomized controlled trials and international registries.

Collaborations and Related Studies

The registry has collaborated with academic consortia, university-based research centers, and international observational cohorts to enable comparative effectiveness research and cross-national benchmarking, facilitating pooled analyses with studies conducted by major research institutes. It has provided a platform for registry-based randomized trials and pragmatic investigations led by academic investigators and clinical trial networks, integrating methodologies used in prominent cardiovascular trials and multicenter studies. Partnerships extend to imaging laboratories, emergency service networks, and pharmacology research groups to study diagnostic modalities, prehospital care, and medication effects.

Limitations and Future Directions

Limitations include potential selection bias from voluntary site participation, variability in case ascertainment across hospitals, and incomplete capture of long-term outcomes in some regions, challenges common to multicenter clinical registries and large observational datasets. Future directions emphasize linkage with national claims databases, biobanks housed at universities, and imaging archives to enable precision medicine analyses, as well as enhanced data harmonization with international registries to support global comparative research. Planned enhancements involve incorporation of electronic health record interoperability standards, machine learning–driven risk prediction tools developed by academic data science groups, and expanded participation by community hospitals to improve representativeness.

Category:Cardiology registries