Impact of cardiac rehabilitation on adherence to secondary prevention measures across STEMI, NSTEMI, and unstable angina pectoris subgroups: a randomized controlled trial in high-risk patients

Background Acute coronary syndrome (ACS) patients with multiple cardiovascular risk factors face particularly high recurrence rates. The differential impact of cardiac rehabilitation across ACS subtypes in high-risk patients remains understudied.Methods This prospective, randomised, single-center study evaluated cardiac rehabilitation effects on adherence across ACS subtypes in high-risk patients. 260 patients with baseline smoking, BMI ≥25 kg/m2, and physical inactivity were randomised 1:1 to cardiac rehabilitation or control groups. Patients were stratified by ACS type: STEMI, NSTEMI, and unstable angina pectoris (UAP). Primary outcomes included adherence to medical treatment, dietary recommendations, physical activity guidelines, smoking cessation, and weight management at one-year follow-up.Results Among 260 patients (130 rehabilitation, 130 control), NSTEMI was most common (45.4%), followed by STEMI (32.7%) and UAP (21.9%). Cardiac rehabilitation significantly improved adherence across all ACS subtypes. Overall adherence rates in rehabilitation vs. control groups were: medical treatment (89.2% vs. 71.5%, p < 0.001), dietary recommendations (82.3% vs. 58.5%, p < 0.001), physical activity (85.4% vs. 42.3%, p < 0.001), smoking cessation (76.9% vs. 43.1%, p < 0.001), and weight management (73.1% vs. 51.5%, p < 0.001). STEMI patients excelled in smoking cessation (84.7% vs. 38.6%), NSTEMI in physical activity (88.1% vs. 40.7%), and UAP in medical adherence (92.9% vs. 75.0%). All-cause rehospitalization rates were significantly lower in the rehabilitation group (12.3% vs. 23.1%, p = 0.023), as were cardiovascular-related rehospitalizations (7.7% vs. 18.5%, p = 0.012).Conclusion Structured cardiac rehabilitation significantly enhances adherence to all secondary prevention measures across STEMI, NSTEMI, and UAP subtypes in high-risk patients, with subtype-specific patterns of improvement.