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.