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Background Coronary artery disease (CAD) is a leading global cause of mortality. Cardiac rehabilitation (CR) plays a crucial role in managing CAD, with exercise a cornerstone intervention. While moderate-intensity continuous training (MICT) is commonly prescribed, high-intensity interval training (HIIT) may provide superior improvements in cardiovascular fitness, functional capacity, and mental health. This review investigates whether HIIT is a more effective, safe, and feasible intervention compared to MICT in patients with CAD.Aim To evaluate the effectiveness, safety, and feasibility of HIIT in patients with CAD.Methods A systematic review was conducted following PRISMA 2020 guidelines. Six databases (PubMed, Cochrane Library, Ovid MEDLINE®ALL, MEDLINE via EBSCO, CINAHL ultimate, and Scopus) were searched for English-language randomised controlled trials (RCTs). Studies were screened using Rayyan. Study quality was assessed using the Cochrane Risk of Bias 2.0 (RoB 2).Results Eleven RCTs involving 930 participants were included. These studies were rated as having overall ‘low’ or ‘some concerns’ risk of bias. HIIT showed greater improvements in VO 2peakcompared to MICT in six studies, while functional capacity improved in both groups in four studies. Both HIIT and MICT improved quality of life, anxiety, and depression, with no significant difference between the groups. Adverse events occurred in less than 1% of the total study participants; four studies reported no adverse events. Adherence to supervised HIIT exceeded 95% across six studies, with one study reporting 100%. Adherence during unsupervised sessions was 53% for HIIT and 41% for MICT.Conclusion HIIT appears to be a promising intervention for patients with CAD in CR settings. While similar improvements were seen between HIIT and MICT on quality of life, depression and anxiety, HIIT may be more effective for improving cardiorespiratory fitness. These findings support the potential of HIIT as a safe and effective intervention for patients with CAD.