Background: The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. Methods and Results: CDC WONDER (Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8–1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8–3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of −0.2 [−0.7 to 0.3, P =0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. Conclusions: Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction–related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.

Background: Cardiac arrest is 1 of the leading causes of morbidity and mortality, with an estimated 340 000 out‐of‐hospital and 292 000 in‐hospital cardiac arrest events per year in the United States. Survival rates are lower in certain racial and socioeconomic groups. Methods and Results: We performed a county‐level cross‐sectional longitudinal study using the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research multiple causes of death data set between 2016 and 2020 among individuals of all ages whose death was attributed to cardiac arrest. The Social Vulnerability Index is a composite measure that includes socioeconomic vulnerability, household composition, disability, individuals from racial and ethnic minority groups status and language, and housing and transportation domains. We examined the impact of social determinants on cardiac arrest mortality stratified by age, race, ethnicity, and sex in the United States. All age‐adjusted mortality rate (cardiac arrest AAMRs) are reported as per 100 000. Overall cardiac arrest AAMR during the study period was 95.6. The cardiac arrest AAMR was higher for men compared with women (119.6 versus 89.9) and for the Black population compared with the White population (150.4 versus 92.3). The cardiac arrest AAMR increased from 64.8 in counties in quintile 1 of Social Vulnerability Index to 141 in quintile 5, with an average increase of 13% (95% CI, 9.8%–16.9%) in AAMR per quintile increase. Conclusions: Mortality from cardiac arrest varies widely, with a >2‐fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the United States based on social determinants of health.

Background: Patients with coronary artery disease or heart failure (HF) face heightened COVID‐19 and cardiovascular risk, yet the long‐term cardiac effects of COVID‐19 vaccination in this population remain uncertain. Methods: We performed a retrospective, propensity‐matched cohort study using the TriNetX US Collaborative Network (December 2020–December 2022). Adults with coronary artery disease or HF were matched 1:1, creating 74 236 vaccinated and 74 236 calendar‐aligned unvaccinated patients. Outcomes included mortality, acute myocardial infarction, stroke, HF hospitalization, deep vein thrombosis/pulmonary embolism, atrial fibrillation hospitalization, myocarditis, pericarditis, percutaneous coronary intervention, and coronary artery bypass grafting at 1‐year and 2‐year follow‐ups. Results: Vaccination was associated with a dose‐dependent reduction in all‐cause mortality. Landmark hazard ratios (HRs) remained favorable, 0.92 (95% CI, 0.89–0.95), 0.99 (95% CI, 0.96–1.02), and 0.72 (95% CI, 0.70–0.74), confirming robustness across time periods. Vaccination was also associated with fewer HF hospitalizations (2‐year HR, 0.90 [95% CI, 0.87–0.94]) and lower revascularization rates (percutaneous coronary intervention HR, 0.87; coronary artery bypass grafting HR, 0.80), while showing no significant association with acute myocardial infarction, stroke, or venous thromboembolism. Although the study was underpowered to definitively assess rare safety events, a small increase in myocarditis was observed (2‐year HR, 1.36), representing a potential safety signal that warrants further investigation; pericarditis was not significantly elevated. Conclusions: COVID‐19 vaccination was associated with a graded reduction in mortality that persisted after landmark adjustment, as well as lower rates of HF admissions and revascularizations. Findings support the use of complete vaccination, including boosters, as part of secondary prevention, pending confirmation in prospective studies.