Login Register Cart 0
Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Impact of Stroke Severity on the Smoking Paradox in Patients Treated with Intravenous Thrombolysis

Author(s): Peng Zhang, Zhen-Ni Guo, Xiu-Li Yan, Fu-Liang Zhang and Yi Yang*

Volume 19, Issue 2, 2022

Published on: 15 June, 2022

Page: [203 - 209] Pages: 7

DOI: 10.2174/1567202619666220530092614

Price: $65

Abstract

Objective: To our knowledge, no previous studies have investigated the impact of stroke severity on the smoking paradox after intravenous thrombolysis (IVT). We aimed to explore the contribution of stroke severity to the association between smoking and stroke prognosis after IVT.

Methods: We enrolled consecutive patients who received IVT within 4.5 hours from stroke onset. A logistic regression model was used to estimate the unadjusted and adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) for poor functional outcome and mortality at 3 months.

Results: Among patients with moderate stroke, smokers experienced a lower risk of 3-month poor outcomes than non-smokers (33.0% vs. 44.4%, unadjusted OR: 0.616; 95% CI: 0.402–0.945). However, among those with severe stroke, smokers had a higher risk of 3-month poor outcomes than non-smokers (81.6% vs. 55.9%, unadjusted OR: 3.496; 95% CI: 1.207-10.127). After adjustment, the negative correlation between smoking and 3-month poor outcome following IVT lost statistical significance in patients with moderate stroke (OR: 0.677 [95% CI: 0.418-1.097]). However, smoking remained a risk factor for 3-month poor outcomes in patients with severe stroke (OR: 4.216 [95% CI: 1.236-14.385]). We also observed a significant interaction between smoking and stroke severity with regard to the risk of poor functional outcomes (p=0.023). However, no such interaction influenced mortality (p=0.901).

Conclusion: Stroke severity affects the association between smoking and 3-month clinical functional outcomes following IVT.

Keywords: Stroke, smoking paradox, thrombolysis, outcome, stroke severity, NIHSS score.

« Previous Next »
[1]
Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ 1989; 298(6676): 789-94.
[http://dx.doi.org/10.1136/bmj.298.6676.789] [PMID: 2496858]
[2]
Cai Y, Xu W, Liu H, et al. Effects of cigarette smoking on older chinese men treated with clopidogrel monotherapy or aspirin monotherapy: A prospective study. Platelets 2020; 31(5): 667-73.
[http://dx.doi.org/10.1080/09537104.2019.1667494] [PMID: 31556777]
[3]
Ali SF, Smith EE, Reeves MJ, et al. Smoking paradox in patients hospitalized with coronary artery disease or acute ischemic stroke: Findings from get with the guidelines. Circ Cardiovasc Qual Outcomes 2015; 8(6) (Suppl. 3): S73-80.
[http://dx.doi.org/10.1161/CIRCOUTCOMES.114.001244] [PMID: 26515213]
[4]
von Martial R, Gralla J, Mordasini P, et al. Impact of smoking on stroke outcome after endovascular treatment. PLoS One 2018; 13(5): e0194652.
[http://dx.doi.org/10.1371/journal.pone.0194652] [PMID: 29718909]
[5]
Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t-PA stroke study group. Stroke 1997; 28(11): 2109-18.
[http://dx.doi.org/10.1161/01.STR.28.11.2109] [PMID: 9368550]
[6]
Ovbiagele B, Saver JL. The smoking-thrombolysis paradox and acute ischemic stroke. Neurology 2005; 65(2): 293-5.
[http://dx.doi.org/10.1212/01.WNL.0000168163.72351.f3] [PMID: 16043802]
[7]
Kvistad CE, Oeygarden H, Logallo N, Thomassen L, Waje-Andreassen U, Naess H. Is smoking associated with favourable outcome in tPA-treated stroke patients? Acta Neurol Scand 2014; 130(5): 299-304.
[http://dx.doi.org/10.1111/ane.12225] [PMID: 24527872]
[8]
Kufner A, Nolte CH, Galinovic I, et al. Smoking-thrombolysis paradox: Recanalization and reperfusion rates after intravenous tissue plasminogen activator in smokers with ischemic stroke. Stroke 2013; 44(2): 407-13.
[http://dx.doi.org/10.1161/STROKEAHA.112.662148] [PMID: 23287785]
[9]
Aries MJ, Uyttenboogaart M, Koch MW, et al. Does smoking influence outcome after intravenous thrombolysis for acute ischaemic stroke? Eur J Neurol 2009; 16(7): 819-22.
[http://dx.doi.org/10.1111/j.1468-1331.2009.02596.x] [PMID: 19473358]
[10]
Moulin S, Padjen-Bogosavljevic V, Marichal A, et al. Influence of differences in case mix on the better outcome of smokers after intravenous thrombolysis for acute cerebral ischemia. Eur Neurol 2012; 67(3): 178-83.
[http://dx.doi.org/10.1159/000334847] [PMID: 22286144]
[11]
Zhang P, Guo ZN, Sun X, Zhao Y, Yang Y. Meta-analysis of the smoker’s paradox in acute ischemic stroke patients receiving intravenous thrombolysis or endovascular treatment. Nicotine Tob Res 2019; 21(9): 1181-8.
[http://dx.doi.org/10.1093/ntr/ntz094] [PMID: 31219582]
[12]
Hussein HM, Niemann N, Parker ED, Qureshi AI. Searching for the smoker’s paradox in acute stroke patients treated with intravenous thrombolysis. Nicotine Tob Res 2017; 19(7): 871-6.
[http://dx.doi.org/10.1093/ntr/ntx020] [PMID: 28339617]
[13]
Tong X, Wang C, Liao X, et al. Smoking-thrombolysis relationship depends on ischemic stroke subtype. Stroke 2016; 47(7): 1811-6.
[http://dx.doi.org/10.1161/STROKEAHA.116.013124] [PMID: 27222526]
[14]
Stroke-1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders. Stroke 1989; 20(10): 1407-31.
[http://dx.doi.org/10.1161/01.STR.20.10.1407] [PMID: 2799873]
[15]
Guidelines for controlling and monitoring the tobacco epidemic. World Health Organization 1998. Available from: https://apps.who.int/iris/handle/10665/42049
[16]
Alberts M, Chen YW, Lin JH, Kogan E, Twyman K, Milentijevic D. Risks of stroke and mortality in atrial fibrillation patients treated with rivaroxaban and warfarin. Stroke 2020; 51(2): 549-55.
[http://dx.doi.org/10.1161/STROKEAHA.119.025554] [PMID: 31888412]
[17]
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993; 24(1): 35-41.
[http://dx.doi.org/10.1161/01.STR.24.1.35] [PMID: 7678184]
[18]
Patel N, Rao VA, Heilman-Espinoza ER, Lai R, Quesada RA, Flint AC. Simple and reliable determination of the modified rankin scale score in neurosurgical and neurological patients: The mRS-9Q. Neurosurgery 2012; 71(5): 971-5.
[http://dx.doi.org/10.1227/NEU.0b013e31826a8a56] [PMID: 22843133]
[19]
Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007; 165(6): 710-8.
[http://dx.doi.org/10.1093/aje/kwk052] [PMID: 17182981]
[20]
Hametner C, Ringleb P, Kellert L. Sex and hemisphere - A neglected, nature-determined relationship in acute ischemic stroke. Cerebrovasc Dis 2015; 40(1-2): 59-66.
[http://dx.doi.org/10.1159/000430999] [PMID: 26184600]
[21]
Nam HS, Lee KY, Han SW, et al. Prediction of long-term outcome by percent improvement after the first day of thrombolytic treatment in stroke patients. J Neurol Sci 2009; 281(1-2): 69-73.
[http://dx.doi.org/10.1016/j.jns.2009.02.365] [PMID: 19304298]
[22]
Kim DH, Bae HJ, Han MK, et al. Direct admission to stroke centers reduces treatment delay and improves clinical outcome after intravenous thrombolysis. J Clin Neurosci 2016; 27: 74-9.
[http://dx.doi.org/10.1016/j.jocn.2015.06.038] [PMID: 26778045]
[23]
Zidovetzki R, Chen P, Fisher M, Hofman FM, Faraci FM. Nicotine increases plasminogen activator inhibitor-1 production by human brain endothelial cells via protein kinase C-associated pathway. Stroke 1999; 30(3): 651-5.
[http://dx.doi.org/10.1161/01.STR.30.3.651] [PMID: 10066866]
[24]
Middleton ET, Morice AH. Breath carbon monoxide as an indication of smoking habit. Chest 2000; 117(3): 758-63.
[http://dx.doi.org/10.1378/chest.117.3.758] [PMID: 10713003]
[25]
Wegener S, Gottschalk B, Jovanovic V, et al. Transient ischemic attacks before ischemic stroke: Preconditioning the human brain? A multicenter magnetic resonance imaging study. Stroke 2004; 35(3): 616-21.
[http://dx.doi.org/10.1161/01.STR.0000115767.17923.6A] [PMID: 14963288]
[26]
Lisi M, Dragoni S, Leone MC, Münzel T, Parker JD, Gori T. Acute (but not chronic) smoking paradoxically protects the endothelium from ischemia and reperfusion: Insight into the “smoking paradox”. Clin Res Cardiol 2013; 102(5): 387-9.
[http://dx.doi.org/10.1007/s00392-013-0540-y] [PMID: 23420028]
[27]
Carnevale R, Sciarretta S, Violi F, et al. Acute impact of tobacco vs electronic cigarette smoking on oxidative stress and vascular.
[http://dx.doi.org/10.1016/j.chest.2016.04.012]

Rights & Permissions Print Cite
Article Metrics
6
© 2024 Bentham Science Publishers | Privacy Policy