Background Chronic total occlusion (CTO) intervention is still challenging because of the limited procedural success rate and higher target failure. It is not clear whether myocardial infarction (MI) can impact on the angiographic and clinical outcomes of CTO intervention in drug eluting stent (DES) era.Methods A total of 181 patients (pts) underwent CTO intervention were divided into the two groups according to presence of previous MI (Previous MI: n=29 pts, non previous MI: n=152 pts). In-hospital, 6-month angiographic and clinical outcomes were compared between the 2 groups. Results The baseline clinical characteristics were similar between the two groups. The overall procedural failure rate was similar but very high between the two groups (96.7% vs 94.1%, p=0.70). Procedure related complications including perforation, dissection and thrombosis were not different between two groups. However, at 6 months, there was a trend toward more incidences of binary restenosis in CTO pts with previous MI and target lesion revascularization (TLR) and major adverse cardiac events (MACE) were higher in the previous MI group (Table).Conclusions CTO pts with a history of previous MI showed worse angiographic and clinical outcomes compared with CTO pts without previous MI up to 6 months, suggesting special care should be focused on this particular subset of pts.