Effects of Cardiac Rehabilitation on Cardiac Function and Cardiovascular Adverse Events in Coronary Heart Disease Patients Following Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Background: Assessment of the influence of the five central cardiac rehabilitation (CR) prescriptions on heart function and cardiovascular complications in individuals with coronary artery disease following percutaneous coronary intervention (PCI). Methods: This systematic review and meta-analysis was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of PubMed, Web of Science, Ovid full-text journals database, Embase, CINAHL, Cochrane Library, MEDLINE, CNKI, VIP, SinoMed, and Wanfang data resources, was performed in November 2024. Studies that met the following criteria were included: (i) Population (P): adult individuals (18 years or older) with a confirmed diagnosis of ischemic heart disease using the clinical gold standard "coronary angiography" and undergoing first-time PCI; (ii) Intervention (I): five core cardiac rehabilitation prescriptions; (iii) Control (C): routine rehabilitation guidance/traditional rehabilitation guidance; (iv) Outcomes (O): left ventricular ejection fraction (LVEF)/left ventricular end-diastolic diameter (LVEDD)/six-minute walk distance (6MWD)/Major Adverse Cardiovascular Events (MACE); (v) Study design (S): randomized controlled trials. Results: This systematic review and meta-analysis of 16 randomized controlled trials (involving 1808 patients) demonstrates that comprehensive Cardiac Rehabilitation (CCR), integrating exercise training, nutritional counseling, smoking cessation support, psychological intervention, and medication management, yields two key benefits for coronary heart disease (CHD) patients following first-time PCI: (1) significant enhancement of cardiac function evidenced by improved LVEF (standardized mean difference (SMD) = 0.56, 95% confidence interval (CI): 0.33 to 0.79), reduced LVEDD (SMD = -0.67, 95% CI: -0.97 to -0.36), and increased exercise capacity (SMD = 0.82, 95% CI: 0.48 to 1.15); (2) substantial reduction in MACE (odds ratios (OR) = 0.15, 95% CI: 0.09 to 0.24). Conclusions: Patients who have undergone first-time PCI for CHD may experience significant advantages from the combined intervention of five CR strategies. Along with adherence to medical therapy and the evolution of medical models, strengthening multidisciplinary cooperation is crucial for optimizing clinical outcomes in patients following coronary interventional procedures. The PROSPERO Registration: CRD42024565139, URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024565139.