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Background Optimal duration of dual antiplatelet therapy (DAPT) after coronary stent implantation depends on bleeding and thrombotic risk in an individual patient. The PRECISE-DAPT score is recommended for adjusting of optimal DAPT duration. Purpose To assess external validation of PRECISE-DAPT score for prediction of out-of-hospital bleeding and thrombosis after coronary stent implantation in prospective manner. Methods We prospectively enrolled patients who underwent coronary stent implantation and received DAPT in our institution during June 2018 through December 2019. Out-of-hospital bleeding and thrombotic events were assessed for validation of PRECISE-DAPT score. Results Six hundred and two patients were enrolled. The mean age was 65.0±11.7 years and 28.2% were female. STEMI, NSTEMI/UA and chronic coronary syndrome were 24.4%, 22.6%, 53% respectively. Prevalence of prior bleeding was 6.3%. Mean follow-up period was 312±72 days. Bleeding events were 5.1%. High PRECISE-DAPT score (score ≥25) had significantly higher bleeding events (9.4% vs 2.4%, P-value &amp;lt;0.001), which were divided into major TIMI bleeding (3.4% vs 0.3%, P-valve 0.003) and minor TIMI bleeding (6.0% vs 2.2%, P-valve 0.014). MACE (CV death, MI, stroke) were 7% and significantly higher in high PRECISE-DAPT score (10.7% vs 4.6%, P-valve 0.004), compared with low PRECISE-DAPT score. Conclusions In real-world prospective study, high PRECISE DAPT score (score ≥25) is associated with high bleeding and thrombotic events. Because of increased both events in high PRECEISE-DAPT score, shortening DAPT duration requires physician final decision-making to balance future bleeding and thrombosis. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Siriraj grants for medical research and education, Faculty of Medicine Siriraj Hospital, Mahidol University

Prospective external validation of PRECISE-DAPT score for prediction of bleeding and thrombosis after coronary stent implantation