Background: The impact of COVID-19 pandemic in Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI) volumes and outcomes remains unknown. Methods: We compared the clin., angiog. characteristics and procedural outcomes of 2,602 CTO-PCIs performed at 21 US and international centers in 2019 vs. 2020. Results: There were 1708 CTO-PCIs performed in 2019 and 975 in 2020 (annualized number) (43% decrease). Compared with 2019, 2020 patients had similar age (65 [58,71] vs. 65 [57,73], p = 0.920), prevalence of diabetes (43.5% vs. 43.8%, p = 0.87) but had higher prevalence of dyslipidemia (95% vs. 86%, p<0.001), hypertension (93.4% vs. 90.6%, p = 0.019) and heart failure (31.1 vs. 27.1%, p = 0.0386). Mean J-CTO score was higher in 2020 (2.54 ± 1.2 vs. 2.37 ± 1.23, p = 0.0009). Use of the retrograde was similar (32% in 2020 vs. 31% in 2019, p = 0.62). Intravascular ultrasound was used more often in 2020 (67.1% vs. 55.7%, p<0.001). Compared with 2019, CTO-PCIs performed in 2020 had similar tech. success (86.6% vs. 86.3%, p = 0.84), procedural success (84.2% vs. 85.3%, p = 0.47) but a higher incidence of in-hospital major adverse cardiovascular events (3.2% vs. 1.6%, p = 0.0094). Conclusion: We observed a 43% decrease in CTO-PCI procedures in 2020 likely due to the COVID-19 pandemic. Patients who underwent CTO-PCI had similar procedural and tech. success in 2020 as compared to 2019 but higher incidence of in-hospital MACE.