D-42 | Trends and Outcomes in Sudden Cardiac Death Mortality Among Adults With Coronary Artery Disease (1999-2024): A Nationwide Analysis

Background: Sudden cardiac death (SCD) is a leading cause of mortality in adults with coronary artery disease (CAD), yet national trends and demographic disparities in CAD-related SCD remain underexplored.Methods: We analyzed CDC WONDER data (1999-2024) for U.S. decedents aged 25 years with SCD (ICD-10: I46) and CAD (ICD-10: I25).Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, region, and urban/rural status.Joinpoint regression was used to estimate average annual percent changes (AAPC) in AAMR.Results: From 1999-2024, there were 149,813 SCD-CAD deaths.The overall AAMR declined from 3.8 in 1999 to 1.6 in 2024 (AAPC: -3.59%, 95% CI: -4.07 to -3.39).Men had higher AAMRs (4.0) than women (1.6).Non-Hispanic (NH) Black adults had the highest AAMR (3.0, 95% CI: 2.7-3.2),followed by NH White (2.8, 95% CI: 2.7-2.9),Hispanic (1.2, 95% CI: 1.0-1.4),and NH Other (1.1, 95% CI: 0.9-1.4).Regionally, the South had the highest AAMR (3.1), followed by the Midwest (3.0), Northeast (2.2), and West (1.8).Rural areas had higher AAMRs than urban areas (4.8 vs. 2.3).Conclusions: SCD mortality among adults with CAD declined significantly from 1999-2018, increased slightly in 2018-2021, and dropped steeply through 2024.Persistent disparities by sex, race, region, and urbanization highlight the need for targeted prevention and community-based interventions.