Cardiovascular Events in Japan

uring the rapid development of imaging modalities in cardiology, nuclear cardiology has played an important role in direct visualization of myocardial ischemia. Its contribution to prognostic evaluation in the USA and Europe has been established and major predictors of cardiovascular events have been assembled in nuclear cardiology guidelines.1 The value of prognostic evaluation and risk stratification using myocardial perfusion imaging (MPI) and single-photon emission computed tomography (SPECT) has been recognized in Japan since the 1990 s. However, because a largescale multicenter study has not been conducted in Japan or other Asian countries, the appropriateness of extrapolating the experience in the USA and Europe to a Japanese population remains unknown. In fact, Japanese governmental statistics indicate that the estimated mortality rate of cardiac disease is half or one-third of that in the USA. Nevertheless, cardiac death was the second leading cause of death (15%) followed by malignant neoplasms (29%) in the 65-year-old subgroup in the 2009 Japanese statistics. Thus, the Japanese-Assessment of Cardiac Event and Survival Study by Quantitative Gated SPECT (J-ACCESS) investigation supported by the Japan Cardiovascular Research Foundation created prognostic databases and evaluated the effectiveness of MPI in the Japanese healthcare system and epidemiological backgrounds.2 The present overview presents the main results of the first Japanese multicenter investigation of coronary artery disease (CAD) using stress myocardial perfusion SPECT, and discusses the role of nuclear cardiology.