Abstract Body (Do not enter title and authors here): Background: Prior data indicated a reduction in mortality among STEMI (ST-elevation myocardial infarction) patients with COVID-19 from 2020 to 2021 in the United States.

Objective: To describe national trends and determinants of outcomes among STEMI patients with COVID-19 from 2020-2021.

Methods: A retrospective cohort study was conducted using the 2020-2021 Nationwide Inpatient Sample of adults diagnosed with STEMI and COVID-19, assessing in-hospital mortality and the use of percutaneous coronary intervention (PCI), mechanical ventilation, and mechanical circulatory support (MCS).

Results: The study included 6,195 STEMI patients with COVID-19 and revealed stable mortality (18% in 2020 to 21% in 2021, p=0.06). Demographic shifts occurred, with White patients increasing from 52% in 2020 to 66% in 2021 (p<0.01). Mechanical ventilation increased in 2021 (Adjusted Odds Ratio [aOR] 1.75; p<0.01).

Compared to White patients, 'Other' race patients had higher odds of mortality (aOR 2.46; p=0.01). Compared to Medicare beneficiaries, Medicaid recipients demonstrated a reduced risk of mortality (aOR 0.47; p=0.02), as did individuals residing in the highest income quartile zip codes compared to the lowest (aOR 0.54; p=0.03). Asian/Pacific Islander patients were less likely to receive PCI (aOR 0.43; p=0.03). Increased MCS was noted in Black (aOR 1.78; p=0.03), Hispanic (aOR 1.87; p=0.01), and 'Other' race patients (aOR 3.78; p<0.01).

Conclusion: This study found no statistically significant change in mortality among STEMI patients with COVID-19 from 2020 to 2021. The findings highlight persistent challenges and the need to improve the equity and effectiveness of cardiac care.