Percutaneous transluminal coronary angioplasty (PTCA) of chronic total occlusions (CTO) is not performed routinely in some centres due to concerns of low procedural success rates and high rates of short-term complications. This retrospective study examines the safety of PTCA to CTO in 100 consecutive cases compared to 100 matched controls. Success rate was 79% for CTO versus 98% for controls (p<0.001), however 5% of CTO patients had a cardiac enzyme rise compared to 13% of controls (p<0.05) and 0% of CTO patients compared to 6% of controls had a significant enzyme rise (p=0.03). These results suggest that PTCA to CTO can be carried out successfully in the majority of patients with only a relatively small risk of myocardial necrosis.