Background: The aim herein, was to assess predictors and current trends of radiation exposure andtotal contrast amount use in patients treated with percutaneous coronary intervention within chronictotal occlusion (CTO PCI) and non-CTO PCI.Methods: Based on a nationwide registry (ORPKI), 535,857 patients treated with PCI between 2014 and2018 were analyzed. The study included 12,572 (2.34%) patients treated with CTO PCI. The CTO PCIand non-CTO PCI groups were compared before and after propensity score matching (PSM). Multifactorialmixed regression models were used to assess predictors of contrast amount use and radiation exposure.Results: The mean total contrast dose and radiation exposure decrease reached statistical significance infollowing years for the CTO PCI (p = 0.002 and p < 0.001) and non-CTO PCI groups (p < 0.001 andp < 0.001). Multifactorial analysis revealed that non-CTO PCI was a strong independent predictor of lowertotal contrast dose (estimate: –17.41; 95% confidence interval [CI]: –18.45 to –16.49, p < 0.001) andradiation exposure (estimate: –264.28; 95% CI: –273.75 to –254.81, p < 0.001). After PSM, it was confirmedthat CTO PCI was an independent predictor of greater radiation exposure (estimate: 328.6; 95%CI: 289.1–368.1; p < 0.001) and total contrast dose (estimate: 30.5; 95% CI: 27.28–33.74; p < 0.001).Conclusions: Contrast dose and radiation exposure have decreased in previous years with regardto the CTO PCI and non-CTO PCI groups. CTO PCI was found to be an independent predictor ofgreater total contrast dose and radiation exposure in the overall group of patients treated with PCI.