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""Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has become the most challenging lessons for interventional cardiologists. Successful recanalization of CTO in patients with viable myocardium may decrease the need for bypass surgery, reduce angina symptoms and improve long-term survival [1], [2], [3]?and?[4]. PCI instruments and the techniques for CTO lesions had improved over time [5], and excellent outcomes have been achieved in multiple pilot studies, especially with the combined use of drug-eluting stents [4], [6], [7]?and?[8]. Ad hoc PCI, in which PCI is performed immediately after diagnostic cardiac catheterization, has become more common due to the potential advantages of cost reduction and shorter hospital stay [9], [10]?and?[11]. However, staged PCI indicates that PCI is performed on different days and it has been well accepted as an alternative check details for complex lesions to lower the possible risk of contrast-induced nephropathy and to increase successful rate [9], [10]?and?[11]. Although the overall mortality rates between ad hoc and staged PCI groups were similar, some high-risk groups such as patients with congestive heart failure during admission and those who with Canadian Cardiovascular Society class IV angina status were associated with an increased rate of mortality [9]. Besides, ad hoc PCI is less likely to be performed for patients with high Syntax Score, CTO, or complex bifurcation lesions because they are anatomically complex [11]. The combined use of the antegrade approach and the retrograde approach has markedly increased the overall success rate, however, SB203580 in vitro it does not increase the rate of major complications [12], [13], [14], [15], [16]?and?[17]. The appropriate use of newly developed techniques and devices raises the successful rate and brings more and more CTO into treatable category [5]. But the appropriate strategy and timing of CTO revascularization remain unknown. The aim of our study was to evaluate the in-hospital and long-term clinical outcomes between ad hoc and staged PCI for CTO in the real world practice. Enrollment criteria included a documented CTO lesion which Alizarin was defined as thrombolysis in myocardial infarction grade (TIMI) of 0 for more than 3?months and the presence of typical angina or reversible myocardial ischemia in a thallium stress study. Exclusion criteria were: 1) a history of acute or recent stroke (