Backgrounds: Chronic total occlusions (CTO) continue to represent a challenge to modern day interventional cardiology. There are limited data on the predictor and impact of successful (CTO) revascularization. Objectives: To identify the pridictor on immediate angiographic success and long-term clinical outcomes in patients undergoing CTO percutaneous coronary intervention (PCI). Methods: From January 2005 to December 2007, all patients underwent PCI for a CTO were consecutively registered. We performed a retrospective study comparing the predictor of procedure failure and the survival between patients with a successful and a failed CTO revascularization. Results: Univariate predictors of technical failure included an previous myocardial infarction(OR 13.1, 95%CI 2.59–65.57. P = 0.002), RCA as target lesion (OR 3.93, 95%CI 1.15–7.82, P=0.025), blunt occlusion stump (OR 3.69, 95%CI 7.69–.25.0, P < 0.001) and fluorotime (OR 0.07, 95%CI 0.95– 0.99, P < 0.002). The observed survival curves for both CTO success and CTO failure patients are shown in Figure. The associated hazard ratio for death with CTO success was 1.33 (95% confidence intervals 0.35–5.12 P=0.68). Death for CTO success patients was 12.5% compared to 9.7% in CTO failure patients(ovall follow up: 2.4 years). Conclusions: Predicts for procedural failure in the recanalization of CTO are revious myocardial infarction, RCA as target lesion, lunt occlusion stump and long fluorotime. There is no significant difference of survival in patients with a failed and successful revascularization of a CTO.