Relationship between platelet aggregation and stroke risk after percutaneous coronary intervention: a PENDULUM analysis

Yuji Matsumaru, Takanari Kitazono, Kazushige Kadota, Koichi Nakao, Yoshihisa Nakagawa, Junya Shite, Hiroyoshi Yokoi, Ken Kozuma, Kengo Tanabe, Takashi Akasaka, Toshiro Shinke, Takafumi Ueno, Atsushi Hirayama, Shiro Uemura, Takeshi Kuroda, Atsushi Takita, Atsushi Harada, Raisuke Iijima, Yoshitaka Murakami, Shigeru SaitoMasato Nakamura

Research output: Contribution to journalArticlepeer-review


In patients undergoing percutaneous coronary intervention (PCI) with a stent, high on-treatment platelet reactivity may be associated with an increased risk of stroke. This post hoc analysis of the PENDULUM registry compared the risk of post-PCI stroke according to on-treatment P2Y12 reaction unit (PRU) values. Patients aged ≥ 20 years who underwent PCI were stratified by baseline PRU (at 12 and 48 h post-PCI) as either high (HPR, > 208), optimal (OPR, > 85 to ≤ 208), or low on-treatment platelet reactivity (LPR, ≤ 85). The incidences of non-fatal ischemic and non-ischemic stroke through to 12 months 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, n = 2227; OPR, n = 3002; LPR, n = 677), 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 (P = 0.037). The incidence of non-fatal non-ischemic stroke was not related to PRU value. When the patients were stratified by PRU ≤ 153 versus > 153 at 12–48 h post-PCI, a significant difference was observed in the cumulative incidence of non-fatal stroke at 12 months (P = 0.044). We found that patients with ischemic stroke tended to have higher PRU values at 12–48 h after PCI versus those without ischemic stroke. Clinical trial registration: UMIN000020332.

Original languageEnglish
Pages (from-to)942-953
Number of pages12
JournalHeart and Vessels
Issue number6
Publication statusPublished - Jun 2022

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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