D-29 | Outcomes of Coronary Artery Bypass Grafting in Rural Hospitals in the United States Following Myocardial Infarction: A Sex-Based Comparison

Background: Racial disparities in ST-elevation myocardial infarction (STEMI) outcomes among Native Americans are poorly understood.We compared demographics, management, and outcomes between Native American and White patients Methods: Adults admitted with primary STEMI were identified from the National Inpatient Sample after excluding COVID-19 hospitalizations.Native American patients were compared with White patients.Multivariable regression assessed differences in revascularization strategies, complications, and in-hospital mortality.Results: Native American patients were younger (61.1 vs 64.6y, p<0.001) with higher comorbidity burden and greater prevalence of diabetes, alcohol use, and drug use.They were more likely to be uninsured or Medicaid insured and to reside in the lowest income quartile (all p<0.001).Native Americans had higher odds of cardiogenic shock (OR 1.20, p=0.025) but lower odds of cardiac arrest and ventricular tachycardia.They were less likely to undergo PCI (OR 0.75, p=0.039), with a trend toward higher CABG use.Overall mortality did not differ significantly.However, among revascularized patients, Native American status was associated with higher mortality (OR 1.37, p=0.017), whereas mortality was similar in non-revascularized patients.Conclusions: Native Americans with STEMI face major socioeconomic and management disparities.Increased mortality in revascularized patients suggests inequities in the quality or timing of invasive care, necessitating targeted interventions.