Background: In the era of drug-eluting stents (DES), minimal data exists regarding the impact of successful revascularization of chronic total occlusion (CTO) on the long-term clinical outcomes. Methods: From retrospective CTO registry, a total of 3,542 patients with CTO who underwent percutaneous coronary intervention (PCI) were enrolled in this study and then classified into two groups according to the success or failure of PCI for CTO; Successful PCI group (n=2,898), defined as the successful recanalization with DES, vs. Failed PCI group (n=644). The primary endpoint was the occurrence of fatal events such as death or fatal myocardial infarction (MI). Results: Median follow up duration were 702 days (interquartile range: 362, 748). The successful PCI group was younger and less previous MI than the failed PCI group. However, other baseline characteristics were similar between both groups. The Successful PCI group showed the significantly lower rate of 2-year mortality (2.1% vs. 4.0%, p=0.010) and composite of death or MI (2.6% vs. 4.8%, p=0.007). On Kaplan-Meier survival analysis, the successful PCI group showed the significantly lower cumulative survival and death or MI-free rates than the failed PCI group (see Figure). On 1:1 matching with propensity score adjusted by age, gender, hypertension, diabetes, previous MI, heart failure and acute coronary syndrome, the successful PCI for CTO group also showed a significantly lower rate of a composite of death or MI than the failed PCI group (p=0.019). Conclusions: Successful revascularization with DES for CTO appears to be closely related with the improved long-term clinical outcomes.