AIMS: Cardiac rehabilitation (CR) after percutaneous coronary intervention (PCI) for acute (ACS) or chronic (CCS) coronary syndrome is underutilised worldwide. The determinants of underuse are not fully understood. Using real-world data, this study explored the effect of socio-geographical factors on CR participation. METHODS: Patients from the Aquitaine region (France) who underwent PCI between 2017 and 2019 were selected from a regional PCI register. Their 1-year CR participation was tracked using the French hospital database. Associations between CR participation and socio-geographical factors, (social deprivation, general practitioner accessibility, and distance to the nearest CR centre) were assessed through logistic regression mixed models at 1 and 3 months in ACS, and at 3 and 6 months in CCS. RESULTS: Among the 19,002 patients, 5,073 (26.7%) participated in CR (ACS: 4,071, 33.0%
CCS: 1,002, 15.0%). A CR centre distance >
25 km reduced participation at 3 months in ACS patients (OR = 0.83, 95% CI: 0.70-0.99, p = 0,023), but not at 1 month after PCI. CCS patients from most advantaged areas were more likely to participate in CR at 3 (OR = 0.62, 95% CI: 0.44-0.88, p = 0.002) and 6 months (OR = 0.59, 95% CI: 0.42-0.82, p <
0.001). General practitioner accessibility did not affect participation. CONCLUSION: Post-PCI CR participation was low. Proximity to CR centres promoted participation for ACS patients, while CR usage correlated with higher socio-economic status for CCS patients. These findings highlight socio-geographical inequalities in CR access, providing a basis for targeted interventions, such as telerehabilitation or expanded coverage.