The purpose of this study is to discuss some issues related to changes in the diagnostic detection of acute myocardial infarction (AMI) and to present international and national experiences of registration of the major coronary events (MONICA project, EUROCISS project, National Register of the major coronary events, experiences based on the use of current health databases). This paper does not take into account activities aimed to assess quality of care given to patients with AMI and/or acute coronary syndromes (ACS), developed in clinical settings or using current data. In Italy there have been few experiences in registration of AMI and/or ACS, some of them are still in progress. Despite the importance of ACS in terms of public health and health care resources utilisation, these initiatives have not led to a registration network with consistent and comparable recording criteria. This problem is very relevant in relation to the significant changes that have occurred in the past, and which continue to occur, in diagnostic and therapeutic criteria. Currently, the geographic and temporal trends of coronary heart disease are only provided by the current data of hospitalization and mortality, with the limits that these databases involve. The presence of ACS registries could provide standardized diagnostic criteria and comparability of results between different areas of the Country, contributing to a better understanding of the epidemiological dynamics of AMI in Italy.