Impact of cardiac rehabilitation on cardiovascular outcomes in patients with coronary artery disease following percutaneous coronary intervention: a meta-analysis

Abstract Background As of 2025, cardiovascular disease (CVD) still remains a major threat to human life. Acute coronary syndrome (ACS) is still considered life-threatening and therefore prompt diagnosis and immediate interventions are mandatory. Nowadays, cardiac rehabilitation (CR) has shown to improve patients’ outcomes following cardiac intervention. In this analysis, we aimed to show the impact of CR on cardiovascular outcomes in patients with coronary artery disease following percutaneous coronary intervention (PCI). Methods Studies which compared the cardiovascular outcomes in participants who were assigned to a CR group versus a control group following PCI were searched from electronic data sources. The cardiovascular outcomes were the main endpoints in this analysis. Statistical analysis was carried out by the Revman software. Risks ratios (RR) with 95% confidence intervals (CIs) were used to represent and describe the results following analysis. Results Fifteen studies with a total number of 115,177 participants were included (38,433 participants were assigned to the CR group and 76,744 participants were assigned to a control group). Our results showed major adverse cardiac events (MACEs) and all-cause mortality to be significantly lower in the CR group with (RR: 0.90, 95% CI: 0.81 – 1.00; P = 0.05) and (RR: 0.69, 95% CI: 0.57 – 0.84; P = 0.0002) respectively. In addition, the risks of heart failure (RR: 0.61, 95% CI: 0.49 – 0.76; P = 0.0001), stable and unstable angina (RR: 0.30, 95% CI: 0.18 – 0.49; P = 0.00001) and arrhythmia (RR: 0.70, 95% CI: 0.61 – 0.81; P = 0.00001) were also significantly lower in the CR group. However, re-stenosis, cardiac death, and recurrent myocardial infarction were similarly manifested. Conclusion Our analysis demonstrated that CR post-PCI could have a positive impact on the adverse cardiovascular outcomes whereby MACEs, all-cause mortality and heart failure were significantly decreased. However, due to the several major limitations of this analysis, future larger trials should confirm our hypothesis.