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This post hoc analysis of the PENDULUM registry compared the risk of post-PCI stroke according to on-treatment P2Y<jats:sub>12<\/jats:sub> reaction unit (PRU) values. Patients aged\u2009\u2265\u200920\u00a0years who underwent PCI were stratified by baseline PRU (at 12 and 48\u00a0h post-PCI) as either high (HPR, &gt;\u2009208), optimal (OPR, &gt;\u200985 to \u2264\u2009208), or low on-treatment platelet reactivity (LPR, \u2264\u200985). The incidences of non-fatal ischemic and non-ischemic stroke through to 12\u00a0months post-PCI were recorded. Almost all enrolled patients (6102\/6267 [97.4%]) had a risk factor for ischemic stroke, and most were receiving dual antiplatelet therapy. Of the 5906 patients with PRU data (HPR, <jats:italic>n<\/jats:italic>\u2009=\u20092227; OPR, <jats:italic>n<\/jats:italic>\u2009=\u20093002; LPR, <jats:italic>n<\/jats:italic>\u2009=\u2009677), 47 had a non-fatal stroke post-PCI (cumulative incidence: 0.68%, ischemic; 0.18%, non-ischemic stroke). Patients with a non-fatal ischemic stroke event had statistically significantly higher post-PCI PRU values versus those without an event (<jats:italic>P<\/jats:italic>\u2009=\u20090.037). The incidence of non-fatal non-ischemic stroke was not related to PRU value. When the patients were stratified by PRU\u2009\u2264\u00a0153 versus &gt;\u00a0153 at 12\u201348\u00a0h post-PCI, a significant difference was observed in the cumulative incidence of non-fatal stroke at 12\u00a0months (<jats:italic>P<\/jats:italic>\u2009=\u20090.044). We found that patients with ischemic stroke tended to have higher PRU values at 12\u201348\u00a0h after PCI versus those without ischemic stroke.<\/jats:p><jats:p>Clinical trial registration: UMIN000020332.<\/jats:p>","DOI":"10.1007\/s00380-021-02003-w","type":"journal-article","created":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T07:16:29Z","timestamp":1641021389000},"page":"942-953","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Relationship between platelet aggregation and stroke risk after percutaneous coronary intervention: a PENDULUM analysis"],"prefix":"10.1007","volume":"37","author":[{"given":"Yuji","family":"Matsumaru","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takanari","family":"Kitazono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazushige","family":"Kadota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Nakao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihisa","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junya","family":"Shite","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyoshi","family":"Yokoi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Kozuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kengo","family":"Tanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Akasaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiro","family":"Shinke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takafumi","family":"Ueno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Hirayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiro","family":"Uemura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Kuroda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Takita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Harada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raisuke","family":"Iijima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshitaka","family":"Murakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Saito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masato","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,1,1]]},"reference":[{"key":"2003_CR1","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/S1474-4422(19)30034-1","volume":"18","author":"GBD 2016 Stroke Collaborators","year":"2019","unstructured":"GBD 2016 Stroke Collaborators (2019) Global, regional, and national burden of stroke, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016. 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Matsumaru has received remuneration from Daiichi Sakyo Co., Ltd., and Otsuka Pharmaceutical Co., Ltd. T. Kitazono has received remuneration and scholarship funds or donations from Daiichi Sakyo Co., Ltd. K. Kadota has received remuneration from Daiichi Sankyo Co., Ltd., and Sanofi K.K. K. Nakao has received remuneration from Daiichi Sankyo Co., Ltd. Y. Nakagawa has received remuneration from Bristol Myers Squibb K.K., Kowa Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Bayer Yakuhin Ltd., Sanofi K.K., Boston Scientific Corporation, and Abbott Medical Japan LLC., and research funding from Daiichi Sankyo Co., Ltd., Bayer Yakuhin Ltd., Sanofi K.K., Boston Scientific Corporation, and Abbott Medical Japan LLC. J. Shite has received remuneration from Daiichi Sankyo Co., Ltd., Nipro Corporation, Abbott Japan LLC, and Terumo Corporation. H. Yokoi has received remuneration and scholarship funds or donations from Daiichi Sankyo Co., Ltd. K. Kozuma has received remuneration and research funding from Daiichi Sankyo Co., Ltd. K. Tanabe has received remuneration from Daiichi Sankyo Co., Ltd., Sanofi K.K., AstraZeneca K.K., Abbott Medical Japan LLC., Boston Scientific Corporation, and Terumo Corporation. T. Akasaka has received remuneration from Abbot Medical Japan LLC., and Otsuka Pharmaceutical Co., Ltd., research funding from Daiichi Sankyo Co., Ltd., scholarship funds or donations from Abbot Medical Japan LLC., Nipro Corporation, and Terumo Corporation, and has a personal relationship with Terumo Corporation. T. Shinke has received remuneration and research funding from Daiichi Sankyo Co., Ltd., Bayer Yakuhin Ltd., Bristol Myers Squibb K.K., and Nippon Boehringer Ingelheim Co., Ltd. T. Ueno received consultancy fees from Japan Medical Device Technology Co., Ltd., and Nipro Corporation. A. Hirayama has received remuneration from Daiichi Sankyo Co., Ltd., Bayer Yakuhin Ltd., and Takeda Pharmaceutical Co., Ltd. S. Uemura has received remuneration from Daiichi Sankyo Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Amgen Astellas BioPharma Co., Ltd., Abbot Medical Japan LLC., Sanofi K.K., Terumo Corporation, and Bayer Yakuhin Ltd.; and research funding from Daiichi Sankyo Co., Ltd.; and scholarship funds or donations from Daiichi Sankyo Co., Ltd., Astellas Pharma Inc., Otsuka Pharmaceutical Co., Ltd., Goodman Co., Ltd., Shionogi Inc., Sumitomo Dainippon Pharma Co., Ltd., Boston Scientific Japan K.K., Kaken Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharmaceutical Co., Ltd., Japan Lifeline Co., Ltd., MSD K.K., Nipro Corporation, Actelion Pharmaceuticals Japan Ltd., Pfizer Japan Inc., Abbot Medical Japan LLC., Sanofi K.K., Terumo Corporation, and Bayer Yakuhin Ltd. T. Kuroda, A. Takita, and A. Harada, are employees of Daiichi Sankyo Co., Ltd. Y. Murakami has received remuneration from SRD Co., Ltd. S. Saito has received consultancy fees from Japan Lifeline Inc., and Terumo Corporation; and remuneration from Daiichi Sankyo Co., Ltd, Abbott Medical Japan LLC., Boston Scientific Corporation, and Medtronic Japan Co., Ltd. M. Nakamura has received remuneration from Daiichi Sankyo Co., Ltd., Sanofi K.K., Terumo Corporation, and Bristol Myers Squibb K.K, and research funding from Daiichi Sankyo Co., Ltd., Sanofi K.K., and Bayer Yakuhin K.K. R. Iijima has no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was performed per the principles of the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects and was registered in the University hospital Medical Information Network (UMIN) Clinical Trial Registry (UMIN 000020332). The study protocol and related documents were approved by the Ethics Committee at Toho University Ohashi Medical Center on 14 December 2015 (reference code: 15-71).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"All patients provided written informed consent before study participation.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}