ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Cardiac Rehabilitation Based on Enhanced External Counterpulsation in Patients with Acute Coronary Syndrome
Chengwen Yang
Zhihua Xiao
Zhengyong Zhang
Jia Hu
Weiyan Wang
Tao Yang
Wei Tan
Yaxin Ten
Lirong Cai
Min Feng
Shiquan Ye
Santai County People's Hospital (Affiliated Hospital of North Sichuan Medical College in Santai County), Mianyang, China
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Abstract
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. Results: 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.
Summary
Keywords
ACS, Acute coronary syndrome (ACS), Enhanced external counterpulsation (EECP), Majoradverse cardiovascular events (MACE), MI
Received
31 July 2025
Accepted
09 February 2026
Copyright
© 2026 Yang, Xiao, Zhang, Hu, Wang, Yang, Tan, Ten, Cai, Feng and Ye. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Chengwen Yang
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