Objective To investigate the predictive value of coronary CT angiography in percutaneous coronary intervention (PCI) treatment for chronic total occlusion (CTO) lesions. Methods The clinical data of 250 CTO patients admitted to our hospital were analyzed retrospectively. The patients were divided into two groups according to their age. Among them, 126 cases(patients younger than 60 years old) were included in the youth group, and 124 cases(patients older than 60 years old) were included in the elderly group. The features of coronary artery angiography, interventional treatment efficacy, success rate of surgery, and echocardiography before and after surgery were compared between the two groups. Results The incidence rate of the three-vessel lesions and left main lesions in the elderly group was higher than that of the youth group (P<0.05). The coronary artery lesions of the left anterior descending and right coronary lesions were more in the elderly group than in the youth group (P<0.05). The incidence rate of the proximal vessel severe tortuosity and calcification of the elderly group was higher than that of the youth group (P<0.05). The elderly group had higher incidence rate of disease with the transradial approach as well as lower incidence rate of transradial approach+ transfemoral approach than those of the youth group (P<0.05). No difference as found in the size of guiding catheter, retrograde wire technique and success rate of surgery (P>0.05). The LVEDD in the youth group had no difference before and after treatment, and the LVEF was increased after treatment (P<0.05). The LVEF in the elderly group had no difference before and after treatment, and the LVEDD was increased after treatment (P<0.05). The LVEDD of the two groups had no difference within groups (P>0.05), and was higher in the youth group than in the elderly group (P<0.05). The LVEF of the two groups had no difference within groups (P>0.05), and was lower in the youth group than in the elderly group (P<0.05). Conclusion The coronary CT angiography can improve the success rate of PCI, and clarify the lesion location, and guide the puncture for CTO patients.