Cardiovascular outcomes of postoperative cardiac rehabilitation in CABG patients receiving critical care services: a TriNetX global federated network study

Background and objectives Coronary artery bypass graft (CABG) remains a major revascularisation strategy for patients with advanced coronary artery disease, and postoperative care is central to longer-term outcomes. We investigated the association between postoperative cardiac rehabilitation (CR) and clinical outcomes among CABG patients who received critical care services. Methods Using the TriNetX research network, we identified patients who underwent elective CABG and received critical care services, and compared those who subsequently participated in CR within 2 months with those without documented CR. The primary outcome was 2-year composite events (death, myocardial infarction, and cerebral infarction). Secondary outcomes were heart failure (HF), incident atrial fibrillation, and dementia. A 1-month landmark period was applied in the analyses to reduce the influence of early events. Results Before propensity score matching (PSM), CABG patients who underwent CR (N=3,569, age: 64.7 ± 9.5, 82.6% male), were younger, more often male and had a higher prevalence of comorbidities, including hypertension, ischaemic heart disease, and heart failure, when compared with those who did not (N=26,493, age: 66.0 ± 10.0, 76.4% male). After PSM (matched N=2,244), CR was associated with significantly lower 2-year risk of composite events (HR: 0.74, 95% CI: 0.65-0.84) and HF (HR: 0.49, 95% CI: 0.38-0.63). Subgroup analyses for 2-year composite events, stratified by age, sex and BMI, were consistent with the primary findings. Conclusion In CABG patients receiving critical care services, CR within 2 months was associated with significantly lower 2-year risk of composite events and HF. These results suggest that the benefits of CR may extend to CABG patients receiving critical care services.