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. 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. 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. 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. This study examined socio-geographical factors associated with participation in recommended cardiac rehabilitation programs following percutaneous coronary intervention in patients with coronary heart disease in France.Only one-third of patients with acute coronary syndrome and 15% of those with chronic coronary syndrome participated in these beneficial programs.Patients with acute coronary syndrome living far from cardiac rehabilitation centres and patients with chronic coronary syndrome living in most deprived areas had reduced access to cardiac rehabilitation programs. General practitioner availability did not seem to influence participation in these programs. Health policies should consider place of residence and socio-economic status as factors influencing participation in cardiac rehabilitation programs and develop standardized post-PCI rehabilitation pathways. These pathways should integrate targeted interventions, such as telemedicine, automatic referrals and increased access to rehabilitation services, to address disparities and improve patient outcomes.< Réduire