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Funding Acknowledgements Type of funding sources: None. Background Although presenting features and early complications of acute myocardial infarction (AMI) are clear to the medical community, little is known about the timing and mode of in-hospital death. The purpose of this study is to characterize the timing and mode of in-hospital death following AMI. Methods We analysed in-hospital deaths among 4800 patients with AMI admitted in a single tertiary centre between 2006 and 2019. Baseline demographic and clinical characteristics, the type of AMI, treatments, the timing and mode of death data were collected. The mode of death, analysed by two independent clinicians in case of doubt, was classified as cardiovascular, which included cardiac and non-cardiac causes, or non-cardiovascular death. Results A total of 194 (4%) patients (pts) aged 76 [68-81] years and 61% males died during the hospital stay in the study period of 10 years. ST segment elevation AMI (STEMI) was the most frequent (70%), mostly of the anterior wall (2/3 of STEMI). Most (48%) of the 194 patients presented in Killip Kimball class IV (48%), and 16% presented in cardiorespiratory arrest. The majority (69%) had undergone myocardial revascularization during hospitalization. Most deaths occurred earlier (median 48 [5-240] hours). Overall, 40% patients died within 24 hours after admission, 12% died during the second day, 19% during days 3–7, 19% during days 8–30, and 10% after day 30 (Figure 1). Cardiovascular (82%) was the most common mode of death, mainly due to cardiac causes (76%) (Figure 2). Re-infarction and bleeding accounted for 3% and 5% of deaths, respectively. The median time delay to death is different according to mode of death (1,4 [0,1-4,9] days for CV death and 19 [7,8- 47,7] days for non-CV death, p = 0,001), whereas the timing and mode of death were similar in STEMI and non-STEMI. Conclusion In this contemporary single-centre population with AMI, the majority of in-hospital deaths occurred early after admission. The largest proportion of modes of death was pump failure. Early diagnosis and treatment may be critical to improve survival after AMI. Abstract Figure. Timing and mode of early death after ACS

Timing and mode of in-hospital death in a contemporary population with acute myocardial infarction