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Aims This study investigated whether a diagnosis of rheumatoid arthritis (RA) affects the quality of inpatient acute myocardial infarction (AMI) care and whether this influences long-term mortality post-AMI.Methods We analysed data from 784,091 adults from England and Wales hospitalised with AMI between Jan 2005 and March 2019 from the Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics mortality data and Hospital Episode Statistics, from where diagnosis of RA was obtained from relevant International Classification of Diseases (ICD)-10 codes. Multivariate cox regression models were used to compare risk of mortality at different time-points (thirty-days, one-year, five-years and to study endpoint (July 31 st, 2021) according to presence of RA. Multiple imputation with ten imputed datasets was used to account for missing data in key covariates of interest. Unadjusted mortality was displayed using the Kaplan-Meier method.Results Patients with RA were older (median age 74 vs. 70 years), more often white (94% vs 91%), female (56% vs. 34%) and have asthma or COPD (22% vs. 15%) (all P<0.001). Patients with RA were less likely to be current smokers (21% vs. 28%), have hypercholesterolaemia (26% vs 32%) or present with STEMI (33% vs. 39%) (all P<0.001). The proportion of AMI patients with a diagnosis of RA increased over the study period from 0.4% (2005) to 1.7% (2019). Patients with RA received less LMWH (49% vs. 55%), but more fondaparinux (42% vs. 30%) (both P<0.001). Patients with RA were less likely to receive ACE inhibitors (71% vs. 75%) or statins (80% vs. 83%) post-AMI (both P<0.001). Rates of invasive coronary angiography, PCI and CABG were similar between groups.RA patients had higher unadjusted inpatient (7% vs. 6%), thirty-day (9% vs. 7%), one-year (20% vs. 16%) and five-year mortality (45% vs. 33%) (all P<0.001). There was no difference in adjusted thirty-day mortality between groups (adjusted Hazard Ratio (aHR): 1.08, 95% CI 0.99–1.19, P=0.087). However, at times beyond this, one-year (aHR: 1.10, 95% CI 1.04–1.17), five-years, (aHR: 1.22, 95% CI 1.17–1.27) and to the end of the study period (aHR: 1.25, 95% CI 1.20–1.30), the risk of all-cause mortality was significantly higher in patients with RA (all P<0.001). Risk of cardiovascular mortality was not significantly different at thirty-days and one-year post AMI, becoming significant at five-years aHR: 1.10, 95% CI 1.03–1.18, P=0.004) and to the study endpoint (aHR: 1.13, 95% CI 1.06–1.20, P<0.001).Conclusion There is an increasing proportion of patients with AMI that have a diagnosis of RA. We found no meaningful disparities in inpatient care according to the presence of RA, however, those with RA have elevated long-term all-cause mortality post-AMI. We suggest that the mortality burden of RA post-AMI is not driven by the quality of AMI care during admission, and is likely suggestive of the progressive nature of RA.Abstract 2-004 Figure 1Kaplan-Meier survival analysis for AMI patients with RA compared to those without