Aim To systematically review the prognostic factors for major adverse cardiovascular events (MACE) in patients with chronic total occlusion (CTO) of coronary artery after percutaneous coronary intervention (PCI).Methods PubMed, EMBASE, the Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect cohort studies on the prognostic factors for MACE in patients with CTO after PCI from inception to October 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies.Then, Meta analysis was performed using R3.6.2 software. Results A total of 30 cohort studies were included, including 25 002 patients with CTO. The results of Meta analysis showed that there were 8 prognostic factors with statistical significance:age (RR＝1.6,5%CI was 1.01～1.10, P＝0.01), male (RR＝1.8,5%CI was 1.17～2.42, P＜0.01), coronary artery bypass grafting history (RR＝1.0,5%CI was 1.12～1.99, P＜0.01), diabetes history (RR＝1.1,5%CI was 1.15～1.99, P＜0.01), renal dysfunction (RR＝2.1,5%CI was 2.44～3.48, P＜0.01), in-stent CTO (RR＝2.5,5%CI was 1.08～4.31, P＝0.03), successful PCI (RR＝0.2,5%CI was 0.38～0.72, P＜0.01) and minimal lumen diameter (RR＝0.7,5%CI was 0.31～0.70, P＜0.01), respectively. Conclusions Current evidence shows that age, male, coronary artery bypass grafting history, diabetes history, renal dysfunction and in-stent CTO were the risk factors for MACE in patients with CTO after PCI. Successful PCI and minimal lumen diameter were the protective factors for MACE in patients with CTO after PCI.