Abstract

Smoking has detrimental effects on the cardiovascular system; however, some studies have reported better clinical outcomes after thrombolysis for ischemic stroke in smokers than in nonsmokers, a phenomenon known as the smoking paradox. Therefore, this study aimed to examine the smoking paradox in patients with ischemic stroke receiving reperfusion therapy. Data were collected from a multicenter hospital-based acute stroke registry in Fukuoka, Japan. The 1148 study patients were categorized into current and noncurrent smokers. The association between smoking and clinical outcomes, including neurological improvement (≥ 4-point decrease in the National Institutes of Health Stroke Scale during hospitalization or 0 points at discharge) and good functional outcomes (modified Rankin Scale score of 0–2) at 3 months, was evaluated using logistic regression analysis and propensity score-matched analysis. Among the participants, 231 (20.1%) were current smokers. The odds ratios (ORs) of favorable outcomes after adjusting for potential confounders were not significantly increased in current smokers (OR 0.85, 95% confidence interval [CI] 0.60–1.22 for neurological improvement; OR 0.95, 95% CI 0.65–1.38 for good functional outcome). No significant association was found in the propensity score-matched cohorts. Smoking cessation is strongly recommended since current smoking was not associated with better outcomes after reperfusion therapy.

Details

Title
Effect of smoking status on clinical outcomes after reperfusion therapy for acute ischemic stroke
Author
Irie, Fumi 1 ; Matsuo, Ryu 1 ; Mezuki, Satomi 2 ; Wakisaka, Yoshinobu 3 ; Kamouchi, Masahiro 4 ; Kitazono, Takanari 5 ; Ago, Tetsuro 3 ; Ishitsuka, Takao 6 ; Ibayashi, Setsuro 7 ; Kusuda, Kenji 7 ; Fujii, Kenichiro 8 ; Nagao, Tetsuhiko 9 ; Okada, Yasushi 10 ; Yasaka, Masahiro 11 ; Ooboshi, Hiroaki 12 ; Irie, Katsumi 13 ; Omae, Tsuyoshi 14 ; Toyoda, Kazunori 15 ; Nakane, Hiroshi 16 ; Sugimori, Hiroshi 10 ; Arakawa, Shuji 17 ; Fukuda, Kenji 18 ; Kitayama, Jiro 19 ; Fujimoto, Shigeru 20 ; Arihiro, Shoji 21 ; Kuroda, Junya 16 ; Fukushima, Yoshihisa 18 ; Nakamura, Kuniyuki 22 ; Kiyohara, Takuya 22 

 Kyushu University, Department of Health Care Administration and Management, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849); Kyushu University, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849); Kyushu University, Center for Cohort Studies, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849) 
 Kyushu University, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849); Kyushu University Hospital, Emergency and Clinical Care Center, Fukuoka, Japan (GRID:grid.411248.a) (ISNI:0000 0004 0404 8415) 
 Kyushu University, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849) 
 Kyushu University, Department of Health Care Administration and Management, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849); Kyushu University, Center for Cohort Studies, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849) 
 Kyushu University, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849); Kyushu University, Center for Cohort Studies, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849) 
 Fukuoka Mirai Hospital, Fukuoka, Japan (GRID:grid.177174.3) 
 Seiai Rehabilitation Hospital, Onojo, Japan (GRID:grid.177174.3) 
 Japan Seafarers Relief Association Moji Ekisaikai Hospital, Kitakyushu, Japan (GRID:grid.177174.3) 
 Seiai Rehabilitation Hospital, Safety Monitoring Committee, Onojo, Japan (GRID:grid.177174.3) 
10  National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (GRID:grid.415613.4) 
11  Fukuoka Neurosurgical Hospital, Fukuoka, Japan (GRID:grid.415613.4) 
12  Fukuoka Dental College Medical and Dental Hospital, Fukuoka, Japan (GRID:grid.418046.f) (ISNI:0000 0000 9611 5902) 
13  Hakujyuji Hospital, Fukuoka, Japan (GRID:grid.177174.3) 
14  Imazu Red Cross Hospital, Fukuoka, Japan (GRID:grid.177174.3) 
15  National Cerebral and Cardiovascular Center, Suita, Japan (GRID:grid.410796.d) (ISNI:0000 0004 0378 8307) 
16  National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (GRID:grid.505833.8) 
17  Steel Memorial Yawata Hospital, Kitakyushu, Japan (GRID:grid.416320.2) (ISNI:0000 0004 1772 1760) 
18  St Mary’s Hospital, Kurume, Japan (GRID:grid.416532.7) (ISNI:0000 0004 0569 9156) 
19  Fukuoka Red Cross Hospital, Fukuoka, Japan (GRID:grid.415148.d) (ISNI:0000 0004 1772 3723) 
20  Jichi Medical University, Shimotsuke, Japan (GRID:grid.410804.9) (ISNI:0000 0001 2309 0000) 
21  Japan Labor Health and Welfare Organization Kyushu Rosai Hospital, Kitakyushu, Japan (GRID:grid.415645.7) (ISNI:0000 0004 0378 8112) 
22  Kyushu University Hospital, Fukuoka, Japan (GRID:grid.411248.a) (ISNI:0000 0004 0404 8415) 
Pages
9290
Publication year
2024
Publication date
2024
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3049086467
Copyright
© The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.