To assess the frequency of totally occluded coronary arteries and their angiographic suitability for catheter-based revascularization in an unselected patient population, all coronary angiograms showing > or = 50% diameter stenosis obtained from patients in a community hospital setting, were reviewed during a 1-year period. There were 112 totally occluded arteries in 101 patients (35%). Based on coronary morphologic variables previously identified as predictive of successful revascularization, 52 (46%) totally occluded arteries were judged suitable for coronary angioplasty. Totally occluded arteries with unfavorable features for coronary angioplasty were present in 29% of patients with multivessel coronary artery disease and were more commonly present in the right coronary artery. Thus totally occluded coronary arteries are found in approximately one third of patients with suspected or known coronary artery disease studied by means of coronary arteriography in a community hospital setting. Approximately one half of the total occlusions have features favoring successful coronary angioplasty.