Objective: Development of chronic total occlusion (CTO) consists of multiple histological stages, with each stage containing different histopathological features. The monocyte to high-density lipoprotein ratio (MHR) is a useful marker of the degree of inflammatory response. The aim of this study was to investigate the relationship between MHR and long-term survival and mortality in CTO patients. Methods: The study included 493 CTO patients that were followed over a period of 73 months between January 2011 and December 2019. MHR was calculated from the venous blood samples taken from each patient immediately before routine coronary angiography. Results: The study included 493 patients comprising 353 (71.6%) men and 140 (28.4%) women with a mean age of 63.03±10.88 years. Median follow-up period was 48 (interquartile range [IQR]: 26-73) months. Patients were divided into two groups: (I) MHR <17.68 (n=278) and (II) MHR ≥17.68 (n=215). Long-term mortality was significantly higher in group II than in group I (n=70, 32.6% vs. n=43, 15.5%; p<0,001). On multivariate logistic regression analysis, MHR was found to be an independent predictor of long-term mortality (Odds Ratio [OR]: 1.089, 95% Confidence Interval [CI]: 1.055-1.124, p<0,001). The Kaplan-Meier analysis showed lower survival rates in group II (MHR ≥17.68) than in group I (MHR <17.68) (75.223±2.670 vs. 89.220±2.102, p<0,001). Conclusion: MHR could be used as a practical universal biomarker of mortality and survival in CTO patients.