Cardiovascular rehabilitation after an acute coronary syndrome (ACS) has become more prescribed; differences still remain in prescription rates. The aim of this work was to assess the prognostic influence of rehabilitation after ACS in the current medical practice.

Our study was based on 2006 data from the French MONICA population-based registry which collects all cases of ACS occurring in people aged 35-74 in 3 French areas. The population consisted of 1838 incident hospitalized ACS after exclusion of those who died in the first 28 days of follow-up. The relationship between prescription of rehabilitation and composite outcome (ACS-recurrence or death) was analyzed using Cox models adjusted for living area, age, number of diseased vessels, diabetes, cardiovascular treatments and delays between symptoms and the first medical care.

There were 171 ACS-recurrences or deaths during a median follow-up of 18.1 months and 23.6% of women. The rate of rehabilitation was higher in men than in women (36 vs. 26%, p<0.0001) and decreased with age. After multivariate adjustment the risk of composite outcome occurrence was identical in men and women for STEMI but higher in women for UA/NSTEMI [adjusted HR 1.75, 95% confidence interval (1.10-2.77)]. Rehabilitation was associated with a decrease of composite outcome whatever the type of ACS [adjusted HR 0.48, (0.32-0.73)]. However a significant interaction between rehabilitation and gender has been found in UA/NSTEMI (p=0.04) but not in STEMI. A stratified analysis for gender in UA/NSTEMI showed a significant benefit of rehabilitation in women [adjusted HR 0.06, (0.01-0.44)] but not in men [adjusted HR 0.82, (0.39-1.72)].

Whatever the definition of ACS, rehabilitation was associated with a reduction of ACS-recurrence and death in both sexes. However it seems to be more beneficial in women presenting UA/NSTEMI in whom it is less prescribed and in whom the rate of recurrence and death is higher.