Cardiac rehabilitation based on enhanced external counterpulsation in patients with acute coronary syndrome

Background Enhanced external counterpulsation (EECP) has been proven to be a safe, effective and low-cost non-invasive treatment method to improve cardiac function and hemodynamic characteristics, especially for patients with refractory angina pectoris and chronic heart failure. However, it is currently unclear whether EECP treatment is still effective in improving the long-term prognosis of patients with acute coronary syndrome (ACS). Objectives This study aimed to investigate the effect of EECP therapy on major adverse cardiovascular events (MACE) in patients undergoing interventional treatment for ACS. Methods and results We conducted a retrospective, controlled trial comparing patients with ACS who received EECP treatment or not from January 2020 to June 2022. A total of 798 patients with ACS who met the study inclusion and exclusion criteria were divided into the No-EECP group ( n = 583) and the EECP group ( n = 215) according to whether EECP treatment was performed, and the primary endpoint analysis was performed. The primary endpoint was the first occurrence of MACE (all-cause death, recurrent angina, coronary revascularization, non-fatal myocardial infarction, and stroke) during a median follow-up period of 16.4 months. At 1 year after discharge, 245 patients (30.7%) underwent repeat coronary angiography. Compared with the No-EECP group, the EECP group had a lower percentage of circumflex artery as the culprit vessel (44.1% vs. 23.7%, p = 0.001) and multivessel coronary artery disease (38.7% vs. 18.6%, p = 0.002). Moreover, patients in the EECP group also had lower Gensini scores ( p < 0.001). During a median follow-up of 16.4 months, the rate of first MACE was significantly higher in the No-EECP group than in the EECP group [19.9% vs. 7.9%; hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.74–0.87; p < 0.001]. Among them, compared with patients in the No-EECP group, EECP group had significantly lower incidences of recurrent angina (7.0% vs. 2.8%; HR: 0.83; 95%CI: 0.74–0.93; p = 0.024) and coronary revascularization (7.5% vs. 3.3%; HR: 0.84; 95% CI: 0.74–0.94; p = 0.028), but no significant differences in the incidences of all-cause death, recurrent myocardial infarction, and stroke. Conclusion EECP treatment was associated with a reduction in MACE in ACS patients, driven primarily by lower rates of recurrent angina and coronary revascularization. Meanwhile, EECP treatment showed potential benefits in attenuating coronary artery disease progression. These findings suggest that EECP may be a promising adjunct to postoperative cardiac rehabilitation in ACS patients, though they require validation in prospective randomized trials.