Background: Worldwide, the rate of aging is highest in Japan, especially the female population. To explore the trends for acute myocardial infarction (AMI) in Japan, the MIYAGI-AMI Registry Study has been conducted for 30 years since 1979, whereby all AMI patients in the Miyagi prefecture are prospectively registered. In 1979,551 AMI patients (male/female 16,238/6,313) were registered from 43 hospitals. The age-adjusted incidence of AMI (/100,000 persons/year) increased from 7.4 in 1979 to 27.0 in 2008 (P<0.001). Although control of coronary risk factors remained insufficient, the rates of ambulance use and primary percutaneous coronary intervention (PCI) have increased, and the overall in-hospital mortality (ageadjusted) has decreased from 20.0% in 1979 to 7.8% in 2008 (P<0.0001). However, the in-hospital mortality remains relatively higher in female than in male patients (12.2% vs 6.3% in 2008). Female patients were characterized by higher age and lower PCI rate. Methods and Results: Conclusions:The MIYAGI-AMI Registry Study demonstrates the steady trend of an increasing incidence, but decreasing mortality, for AMI in Japan over the past 30 years, although the female population still remains at higher risk for in-hospital death, despite improvements in the use of ambulances and primary PCI. (Circ J 2010; 74: 93 - 100)

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp are-metal stents (BMS) and, more recently, drug-eluting stents (DES), such as sirolimus-eluting (Cypher TM ) and paclitaxel-eluting stents (Taxus TM ), have further improved early results and reduced the risk of restenosis. 1,2 However, DES have also not been shown to improve longterm survival of patients with coronary artery disease (CAD) compared with BMS. 3 Moreover, there is a concern on the safety issues of DES, given the potential for late stent thrombosis, especially after discontinuation of dual antiplatelet therapy. 4 Another concern is the DES-induced impairment of coronary vasomotion. 5-10 Indeed, enhanced coronary vasoconstriction in response to acetylcholine (ACh) 5-8 or exercise 9 was demonstrated in the coronary segments adjacent to DES, but not in those adjacent to BMS, and sudden cardiac arrest was reported among patients with severe coronary vasospasm following DES implantation. 10 Patients implanted with DES have a higher rate of positive exercise stress test than patients implanted with BMS 1 month after percutaneous coronary intervention (PCI), 11 which might also indicate DES-induced vasomotor dysfunction. Editorial p 2536Rho-kinase is one of the downstream effectors of the small

The GPS, which is based on systemic inflammation, is useful for predicting the prognoses of hospitalized patients with ADHF.

We aimed to design a rapid and reliable method to identify coronary lesions at high risk for the no-reflow phenomenon before elective coronary stent implantation using integrated backscatter intravascular ultrasound (IB-IVUS). The no-reflow phenomenon occurring during elective percutaneous coronary intervention (PCI) worsens patient prognosis, regardless of whether the phenomenon is transient or persistent. We retrospectively studied 353 coronary lesions to identify factors potentially promoting the no-reflow phenomenon, including lesion location and severity. We also performed component analysis by two- and three-dimensional IB-IVUS before elective stent implantation. The cutoff values of the true lipid volume and estimated lipid volume (lipid area at the minimal lumen diameter site × total stent length) for the no-reflow phenomenon were determined by receiver operating curve analysis. Type C lesions, regardless of location and a thrombolysis in myocardial flow grade of 0, were risk factors for the no-reflow phenomenon during PCI. The estimated lipid volume was significantly correlated with the true lipid volume (R = 0.778, p< 0.0001). The cutoff value of the estimated lipid volume for the no-reflow phenomenon was 132.6 mm (area under the curve = 0.719), and the predictive value was equivalent to that of the true lipid volume. Lesions with an estimated lipid volume of ≥132.6 mm had a significantly higher risk of the no-reflow phenomenon during elective stent implantation (odds ratio, 4.35; 95 % confidence interval, 1.67-12.7; p = 0.0024). The simple and rapid measurement of the estimated lipid volume immediately before stenting during PCI constitutes a reliable predictor of lesions at high risk for the no-reflow phenomenon.