Objective To validate the application of dual antiplatelet therapy (DAPT) score for the antiplatelet treatment in patients with coronary chronic total occlusion (CTO) after percutaneous coronary intervention (PCI). Methods A total of 497 patients with the consecutive CTO who underwent PCI in Bethune International Peace Hospital from January 2014 to June 2017 and then treated with DAPT for 12 months (the standard group) or prolonged to 12-58 months (the prolonged group)were enrolled in this study. The incidences of bleeding and major cardiovascular and cerebrovascular events (MACCE) were observed and compared between the patients with DAPT score ≥2points and <2points, and between those from the standard and prolonged groups. SPSS statistics 22.0 was used for data analysis. Results A total of 405 patients were enrolled in the final analysis, with follow-up period of 34 (28-44) months. (1) In the patients with DAPT score ≥2points, the incidence of MACCE was significantly lower in the prolonged group than in the standard group (5.5% vs 14.0%, P=0.040). The prolonged group had obviously lower rate of cardiac death (1.8% vs 8.6%, P=0.046) and incidence of target vessel revascularization (1.8% vs 8.6%, P=0.046) when compared with the standard group. Kaplan-Meier analysis showed that there was statistical difference in the MACCE-free survival rate between the prolonged and standard groups (P=0.046). (2) In the patients with a DAPT score <2points, there was no significant difference in the incidence of MACCE between the 2 groups. But the occurrence of Bleeding Academic Research Consortium (BARC) type 2,3,5 bleeding was significantly lower in the standard group than in the prolonged group (3.4% vs 12.8%, P=0.018). Kaplan-Meier analysis that indicated the standard group obtained notably higher bleeding-free survival rate than the other group (P=0.034). Conclusion DAPT score can be used to guide DAPT in CTO patients after PCI. The patients with the score ≥2points might benefit from prolonged DAPT, while for those with the score <2points, standard treatment should be carried out to decrease the risk of bleeding events.