D-15 | Trends and Disparities in Premature Heart Disease Mortality in the United States, 2018–2023

with a primary diagnosis of STEMI using ICD-10-CM codes.Patients who underwent fibrinolytics or PCI on the same day were included.National estimates were calculated using appropriate weights.Results: Among 851,204 STEMI admissions, 8,805 (1.0%) received primary fibrinolytic therapy, and 642,875 (75.5%) underwent primary PCI.Demographics were similar between the fibrinolytic and PCI groups: hypertension (71.3% vs. 72.2%),diabetes (31.9% vs. 31.1%),chronic kidney disease (6.5% vs. 5.7%), female sex (29.0% vs. 28.5%),and mean age (63.9 vs. 62.5 years).Fibrinolytic use declined from 1.4% in 2016 to 0.9% in 2020 (p-trend <0.0001), with the Pacific region showing the highest use (2.2%).Only 4.9% of fibrinolytic-treated patients were transferred to another hospital.In-hospital mortality was higher for fibrinolytics (9.3%) compared to primary PCI (5.2%).Cardiogenic shock occurred in 15.0% of fibrinolytic patients vs. 12.0% with PCI.Among fibrinolytic patients, 87.0% eventually underwent PCI during the same hospitalization, reducing mortality to 5.8%.Those who did not undergo PCI had significantly higher mortality (32.3%), with 40.2% mortality among patients who remained at the same hospital without PCI.Transferred patients were older compared to those who remained at the same facility (mean age 68.7 vs. 63.6 years).Conclusions: Fibrinolytic therapy in STEMI is infrequent, with high inhospital mortality, especially in patients not undergoing PCI or transfer.These findings highlight the critical need for timely PCI or transfer after fibrinolytic therapy to improve outcomes, in line with guideline recommendations.