The therapeutic goal of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is to relieve symptoms and improve quality of life, avoid cardiac sequelae and more invasive coronary artery bypass grafting (CABG), and prolong life.

The evidence (6 RCTs, n=1,911) indicates that PCI for CTO is more effective and as safe as optimal medical therapy (OMT) alone in terms of alleviating angina pectoris symptoms and improving quality of life. An adequate safety profile of PCI in CTO was further confirmed by four cohort studies (n=3,593). However, compared with CABG, the evidence from one RCT (n=460) and two cohort studies (n=3,025) is insufficient to draw conclusions on comparative efficacy and safety. There are currently five ongoing trials, none of which compare PCI with CABG in CTO.