Multi-vessel coronary artery disease (CAD) is commonly seen in patients undergoing primary percutaneous coronary intervention (PCI) in the setting of an acute coronary syndrome (ACS) and is associated with impaired prognosis . More specifically, in patients presenting with an acute myocardial infarction (AMI) , the prevalence of chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA) is 8 % to 15 %. Several previous reports have observed that a concurrent non-IRA CTO significantly increased mortality risk beyond the presence of multi-vessel disease without a CTO .