Objective To investigate the factors affecting recanalization of coronary chronic total occlusion (CTO) using ante-rograde technique in the elderly. Methods A total of 301 CTO patients were recruited, who had undergone anterograde percutaneous coronary intervention (PCI) in the General Hospital of Shenyang Military Command from January 2013 to December 2014. According to whether the operation was successful, the patients were divided into PCI success group(n=250) and PCI failure group(n=51). Data were retrieved and compared of their basic information, clinical characteristics and adverse events. SPSS statistics 21.0 was used for statistical analysis. Depending on data type, independent samples t-test or Chi-square test was employed for comparison between groups. Binary logistics regression was performed to analyze the factors associated with success rate of CTO PCI. Results The overall success rate was 83.1%(250/301). There were significant differences between two groups in body mass, body mass index, systolic blood pressure (SBP), diabetes, smoking, New York Heart Association (NYHA) class, tortuosity in the occluded segment, bridging collateral vessels, occlusive time grading, and CTO target vessel (P<0.05). There were no significant differences between two groups in mortality [0.8%(2/250) vs 1.9%(1/51)], heart failure [4.4%(11/250) vs 3.9%(2/51)], postoperative bleeding [3.2%(8/250) vs 3.9%(2/51)], stroke [0%(0/250)vs 0%(0/51)] and perioperative myocardial infarction [4.0%(10/250) vs 3.9%(2/51)] (P>0.05). Binary logistic regression analysis showed female (OR=5.608,5%CI 1.650-19.069, P=0.006), high SBP(OR=1.034,5%CI 1.004-1.064, P=0.024), previous acute myocardial infarction (AMI) (OR=7.213,5%CI 1.070-48.645, P=0.042), left anterior descending (LAD) branch target lesion (OR=2.943,5%CI 1.085-7.984, P=0.034), using the Fielder XT guidewire first (OR=2.570,5%CI 1.049-6.295, P=0.039) were factors that increased procedural success rate; however, diabetes (OR=0.219,5%CI 0.086-0.562, P=0.002), a history of renal insufficiency (OR=0.336, 95%CI 0.117-0.967, P=0.043), higher NYHA class (OR=0.238,5%CI 0.110-0.515, P=0.000), tortuosity of the target vessel (OR=0.130,5%CI 0.017-0.969, P=0.047) and bridging collateral vessels (OR=0.171, 95%CI 0.046-0.634, P=0.008) were factors decreasing procedural success rate. Conclusion The success rate of coronary CTO with anterograde technique increases in the elderly female with an AMI history, LAD target lesion, higher SBP, and using Fielder XT guidewire first, providing valuable clinical reference.