Comprehensive cardiac rehabilitation programme enhances outcomes among early survivors of acute coronary syndrome - A Nationwide registry analysis.

OBJECTIVES

Coronary artery disease remains the leading cause of death globally. Although early myocardial infarction management has improved, long-term secondary prevention remains challenging. This study evaluated the impact of comprehensive cardiac rehabilitation on long-term mortality among acute coronary syndrome survivors and examined factors influencing participation.

METHODS

Data were drawn from the National Myocardial Infarction Registry, including 158,599 patients who survived 30 days after myocardial infarction between 2014 and 2024. Date of data collection was JUL/31/2025. Propensity score matching generated 27,640 matched pairs. All-cause mortality was assessed over a median 4.3-year follow-up; Rosenbaum bounds evaluated sensitivity to hidden bias.

RESULTS

Comprehensive cardiac rehabilitation participation was low (17.4%), highest in ST-elevation myocardial infarction patients (24.6%), and lowest among non-ST-elevation myocardial infarction patients without percutaneous intervention (7.4%). Mortality was 37.4% in non-participants and 24.8% in participants. Adjusted analysis showed a 12.9% absolute mortality reduction and 34% relative risk reduction (number needed to treat = 8). Older age, non-ST-elevation myocardial infarction diagnosis, and conservative management predicted non-participation.

CONCLUSIONS

Cardiac rehabilitation confers significant survival benefits after myocardial infarction, but remains underutilised, especially among high-risk groups. Active enrolment strategies and diverse rehabilitation modalities are needed to improve participation and outcomes.