Twenty-Year Clinical Experience of the Korea Acute Myocardial Infarction Registry

The Korea Acute Myocardial Infarction Registry (KAMIR) was established in 2005 to address the paucity of large-scale, real-world evidence on acute myocardial infarction (AMI) in East Asia. Over the last 2 decades, KAMIR has enrolled more than 86,000 patients across multiple centers in Korea, enabling comprehensive analyses of epidemiology, risk profiles, risk stratification, acute interventional management, and medical therapies. The registry has documented temporal shifts from ST-segment elevation myocardial infarction to non-ST-segment elevation myocardial infarction, progressive population aging, and distinctive metabolic risk profiles characterized by a high prevalence of diabetes and low levels of high-density lipoprotein cholesterol. KAMIR has also supported the development and validation of prognostic tools, including the KAMIR risk score and artificial intelligence-driven models. Widespread adoption of primary percutaneous coronary intervention, advanced stent technologies, intravascular imaging, and tailored antithrombotic strategies have improved procedural success rates and reduced mortality. Long-term medical therapy findings underscore the importance of intensive lipid-lowering, optimized renin-angiotensin system blockade, and individualized antiplatelet regimens, with emerging evidence supporting sodium-glucose cotransporter 2 inhibitors. KAMIR evidence has informed national guidelines and holds strong potential to guide future East Asian consensus guidelines, highlighting the value of region-specific data in shaping global cardiovascular practice. Ongoing integration of precision medicine approaches, digital health tools, and multinational collaboration is expected to further advance AMI care in East Asia.