Aims and objectives <p>This exploratory secondary analysis of a randomized controlled trial — originally powered for medication adherence — investigated associations of a nurse-led Phase I cardiac rehabilitation pathway, integrated with narrative nursing, with anxiety and autonomy following percutaneous coronary intervention (PCI). All psychological analyses are exploratory and intended for hypothesis generation, not causal inference. Findings were interpreted within the transactional model of stress and coping, complemented by narrative nursing theory, focusing on how narrative engagement may help patients reconstruct a sense of control, confidence, and active participation during recovery–addressing narrative foreclosure and supporting autonomy beyond symptom alleviation.</p> Background <p>Phase I cardiac rehabilitation is essential for percutaneous coronary intervention patient, yet standardized nurse-led protocols are lacking and psychological effects remain incompletely understood. Routine care typically delivers didactic education without attending to patients' fears and self-doubt, potentially trapping them in narrative foreclosure. Narrative medicine suggests that providers acting as story witnesses may help transform stagnant trauma narratives into open recovery narratives, reducing threat perception and fostering engagement.</p> Design <p>A 6-month, parallel-group, assessor-blinded randomized controlled trial.</p> Methods <p>This exploratory analysis enrolled 162 post-PCI patients, who were randomized to an intervention group (<i>n</i> = 81) or a control group (<i>n</i> = 81). The intervention group received a nurse-led, structured Phase I cardiac rehabilitation pathway developed from evidence-based principles and adapted to local practice, supplemented with narrative nursing modules targeting the relief of narrative foreclosure. The control group received conventional care. Outcomes were assessed using the Cardiac Rehabilitation Inventory at baseline, 7&#xa0;days post-discharge, and at 1, 3, and 6&#xa0;months, and were analyzed using repeated-measures analysis of variance (ANOVA), with ANCOVA applied for outcomes with baseline imbalances. All analyses of psychological outcomes were exploratory.</p> Results <p>After baseline adjustment, the intervention group showed significantly lower process anxiety at all follow-ups (<i>F</i> = 7.323, <i>P</i> = 0.008). For outcome anxiety, neither the group main effect (<i>F</i> = 2.088, <i>P</i> = 0.151) nor group × time interaction (<i>F</i> = 0.439, <i>P</i> = 0.725) reached significance, though the intervention group maintained numerically lower scores. For autonomy, significant main effects of time (<i>F</i> = 90.900, <i>P</i> &lt; 0.001) and group (<i>F</i> = 36.843, <i>P</i> &lt; 0.001), and a significant time × group interaction (<i>F</i> = 27.814, <i>P</i> &lt; 0.001) were observed, with between-group differences widening over six months.</p> Conclusions <p>In this exploratory analysis, a nurse-led pathway incorporating narrative components was associated with improvements in process anxiety and autonomy, though its association with outcome anxiety remained unclear after adjustment. These patterns are consistent with the possibility that structured narrative engagement may help disrupt closed situational trauma narratives, with the progressive widening of the autonomy gap suggesting a gradual reconstruction toward more agentic self-management. Interpreted within the integrated stress-coping and narrative framework, these hypothesis-generating results suggest that inpatient narrative intervention may be more relevant to alleviating proximal rehabilitation uncertainties than long-term fears. Confirmatory trials powered for psychological endpoints are warranted.</p> Relevance to clinical practice <p>This structured pathway offers a practical framework for systematizing inpatient cardiac rehabilitation and addressing narrative needs. The sustained reduction in process anxiety suggests combining protocols with narrative engagement may help establish a lower threat baseline early in recovery. The widening autonomy gap over follow-up raises the possibility that narrative reconstruction continues post-discharge, empowering self-management. Given the exploratory, single-center nature, findings should be interpreted as preliminary and hypothesis-generating.</p> Trial registration <p>ChiCTR2500114277 (retrospectively registered on December 10, 2025), <a href="https://www.chictr.org.cn">https://www.chictr.org.cn</a>. </p>