Background The purpose of this registration is to follow incidence and case fatality trend of acute myocardial infarction (AMI) in Japan, using a whole community population disease registry that surveys the most up-to-date information. Since the 1970s, mortality from coronary heart disease has followed a declining trend in Japan, which has been attributed to a decrease in the incidence of AMI and some evidence suggests that incidence has leveled off during the past couple of decades. These reported decreasing or stable trends in AMI have been observed despite recent worsening of the cardiovascular risk factor situation in Japan (Japanese paradox). Therefore, monitoring the disease course of AMI is of immense importance. Methods and Results The Takashima AMI Registry established in 1988 covers a stable population of approximately 55,000 in Takashima County in central Japan. Registered patients included all Takashima County residents who have been diagnosed with AMI. The criteria of AMI are in accord with those of the World Health Organization's Monitoring of Trends and Determinants in Cardiovascular Disease (WHO-MONICA) project. Conclusion Comprehensive disease registry data is especially appropriate for determining the incidence as well as the trend of diseases such as AMI. This registration study covering an entire community will enable researchers to follow trends in AMI incidence with a high degree of precision. (Circ J 2007; 71: 1617 - 1621)