Post-acute coronary syndrome cardiovascular rehabilitation: insights into endpoints, biomarkers and clinical practice.

Cardiac rehabilitation (CR) is a multidisciplinary intervention central to secondary prevention after acute coronary syndromes (ACSs), combining medical management, structured exercise, psychological support and lifestyle modification. CR reduces mortality, recurrent events and hospitalisations, while improving quality of life and functional capacity. Its benefits extend beyond physical recovery to include mitigation of systemic inflammation, attenuation of adverse cardiac remodelling and promotion of long-term behavioural change. Recent advances have expanded the scope of CR. Digital health tools, telemedicine and hybrid delivery models have improved accessibility and adherence, particularly in resource-limited settings. Pharmacological innovations, such as PCSK9 inhibitors, inclisiran and agents targeting lipoprotein(a) and inflammation, contribute to residual risk reduction when integrated into CR. Mind-body interventions, including yoga, tai chi and Qigong Baduanjin, offer additional physiological and psychological benefits, especially in elderly or deconditioned patients. The use of advanced functional assessments, including cardiopulmonary exercise testing and ventilatory thresholds, facilitates personalised risk stratification and training prescription. Despite these developments, access to CR remains limited, with significant variability in implementation and participation across regions. Addressing these gaps requires harmonised referral systems, multidisciplinary coordination and patient-centred strategies. Ongoing research should focus on integrating emerging therapies and technologies to enhance personalisation, promote equity and expand CR applications across broader patient populations.