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Purpose: Many recent studies have reported that successful percutaneous coronary intervention (PCI) with drug-eluting stents(DESs) for chronic total occlusion (CTO) has more beneficial effects than failed CTO-PCI; however, there are only limited dataavailable from comparisons of successful CTO-PCI with medical therapy (MT) in the Korean population. Materials and Methods: A total of 840 consecutive CTO patients who underwent diagnostic coronary angiography, receiving eitherPCI with DESs or MT, were enrolled. Patients were divided into two groups according to the treatment assigned. To adjust forpotential confounders, propensity score matching (PSM) analysis was performed using logistic regression. Individual major clinicaloutcomes and major adverse cardiac events, a composite of total death, myocardial infarction (MI), stroke, and revascularization,were compared between the two groups up to 5 years. Results: After PSM, two propensity-matched groups (265 pairs, n=530) were generated, and the baseline characteristics were balanced. Although the PCI group showed a higher incidence of target lesion and vessel revascularization on CTO, the incidence ofMI tended to be lower [hazard ratio (HR): 0.339, 95% confidence interval (CI): 0.110 to 1.043, p=0.059] and the composite of totaldeath or MI was lower (HR: 0.454, 95% CI: 0.224 to 0.919, p=0.028), compared with the MT group up to 5 years. Conclusion: In this study, successful CTO PCI with DESs was associated with a higher risk of repeat PCI for the target vessel, butshowed a reduced incidence of death or MI.
