Return to work (RTW) after an acute coronary syndrome (ACS) is a crucial aspect of the recovery process, particularly in younger individuals. Several clinical, angiographic, and socioeconomic factors influence RTW, including LVEF, cardiovascular risk factors (CVRF), the complexity of coronary artery disease (CAD), and the type of revascularization performed.

To determine the timeframe for RTW, identify independent predictive factors, and assess the impact of complete revascularization on post-ACS outcomes.

We conducted a prospective, single-center study including 129 patients hospitalized for a first ACS episode. All had been professionally active for at least 6 months before the event. Data collection covered demographics, CVRF, clinical severity (Killip, LVEF), angiographic findings, revascularization status (angioplasty vs. coronary bypass), comorbidities, and quality-of-life assessments. Patients were stratified by SYNTAX score into 3 groups: < 22, 23–32, > 32. Follow-ups at 1, 3, 6, and 12 months assessed RTW and cardiovascular events MACE.

The mean age was 51.5 ± 6.4 years; RTW occurred in 84% of patients within six months. Univariate analysis identified factors favoring RTW – LVEF ≥ 45% ( P = 0.001), Killip I ( P = 0.009), absence of in-hospital complications ( P = 0.044), lower smoking history ( P = 0.025), stable employment (p = 0.05), higher physical activity levels ( P = 0.001) – while a low SYNTAX score < 22 was strongly associated with faster RTW ( P = 0.028) and intermediate/high scores correlated with delay; patients undergoing complete revascularization showed a significantly higher RTW rate ( P = 0.039) compared to those with incomplete revascularization. Multivariate analysis confirmed that having fewer than three dependent children (OR = 7.7; P = 0.046) independently accelerated RTW, whereas diabetes (OR = 0.52; P = 0.041), chronic kidney disease (OR = 0.49; P = 0.037) and obesity (OR = 0.56; P = 0.045) independently delayed RTW; at 12 months, early RTW was associated with a significantly lower incidence of MACE ( P = 0.022), including recurrent ACS, heart failure and cardiovascular mortality, and patients with high SYNTAX > 32 had a three-fold higher MACE rate ( P = 0.015) ( Figure 1 ), reinforcing the prognostic value of CAD complexity.

SYNTAX score, completeness of revascularization and key comorbidities shape RTW and 1-year prognosis after ACS. Targeted multidisciplinary rehabilitation aiming for complete revascularization may optimize both occupational and cardiovascular recovery.