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: 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.

Background: Optimal duration and choice of antiplatelet therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention remain controversial. Methods and Results: Digital databases (PubMed, Cochrane, and Embase) were queried to select all randomized controlled trials on a post–percutaneous coronary intervention population with acute coronary syndrome. Dual‐antiplatelet therapy (DAPT) with aspirin and clopidogrel for 12 months was compared with 4 major strategies: high‐potency, high‐ to low‐potency, low‐dose, and short‐duration DAPT. A network meta‐analysis was performed to compare the safety and efficacy of different antiplatelet strategies. This study was the second updated manuscript under the International Prospective Register of Systematic Review registration (CRD42021286552). Thirty‐two randomized controlled trials comprising 103 459 (51 750 experimental, 51 709 control) patients were included. Compared with DAPT with aspirin and clopidogrel for 12 months, high‐ to low‐potency DAPT (risk ratio [RR], 0.69 [95% CI, 0.52–0.92]) and aspirin+prasugrel containing DAPT for 12 months (RR, 0.84 [95% CI, 0.72–0.98]) had a significantly lower, whereas DAPT for 1 month followed by clopidogrel only (RR, 1.59 [95% CI, 1.06–2.39]) had a higher, incidence of major adverse cardiovascular events at 1 year (median follow‐up). Prasugrel (RR, 1.35 [95% CI, 1.09–1.66]) and ticagrelor (RR, 1.38 [95% CI, 1.17–1.62]) containing DAPT for 12 months had significantly higher rates, whereas high‐ to low‐potency DAPT (RR, 0.85 [95% CI, 0.63–1.15]) had no significant risk of major bleeding. Conclusions: Aspirin and ticagrelor for 3 months, followed by aspirin and clopidogrel for the remaining duration, can be considered the optimal strategy for treating post–percutaneous coronary intervention patients with acute coronary syndrome because of a significantly reduced risk of major adverse cardiovascular events without increasing the risk of bleeding.

Importance: Cardiac arrest affects over 600,000 in the US. Despite large-scale public health and educational initiatives, survival rates are lower in certain racial and socioeconomic groups. Objective: To examine the trends in annual rates of cardiac arrests mortality among adults stratified by age, race, and gender in the U.S. Design: A county-level cross-sectional longitudinal study using death data from the Centres for Disease Control and Prevention’s (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 1999 to 2020. Setting: Using the multiple causes of death dataset from the CDC’s WONDER database, cardiac arrests were identified using the International Classification of Diseases (ICD), tenth revision, clinical modification codes. Participants: Individuals aged 15 years or more whose death was attributed to cardiac arrest. Exposures: Calendar year. Main outcomes and measures: National trends in annual mortality from cardiac arrest in select demographic groups and at the state level. Results: Between 1999 and 2020, the annual cardiac arrest related AAMR (CA-MR) declined through 2019 (132.9 to 89.7 per 100,000 residents, followed by an increase in 2020 (104.5 per 100,000). White patients constituted 82% of all deaths and 51% were female. The overall CA-MR during the study period was 104.48 per 100,000 persons. The CA-MR was higher for men as compared with women (123.5 vs. 89.7 per 100,000) and higher for Black as compared with White adults (154.4 vs. 99.1 per 100,000). Conclusion and relevance: CA-MR in the overall population has declined, followed by an increase in 2020, which is likely the impact of COVID-19 pandemic. There were also significant racial and sex differences in mortality rates. Visual Visual representation of cardiac arrest-related mortality and the impact of social vulnerability index on mortality rates ⁴² Key Points: Question What are the temporal trends on cardiac arrest-related deaths in the United States (U.S.)? Findings In this national cross-sectional study spanning 22 years, there was an overall declining trend in cardiac arrest mortality across all age groups, gender, race, and regions. However, in 2020 there was an increase in the rates of cardiac arrest mortality, likely due to the COVID-19 pandemic. There was also a state-level variation in cardiac arrest mortality, with certain states showing an increase in mortality rates. Meaning There was an overall reduction in the age-adjusted mortality rates due to cardiac arrest. This decrease in mortality rate was consistent across all genders, races, and US regions. There was also significant racial and sex differences in mortality rates.