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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.
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1 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)
2 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)
3 Kyushu University, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Fukuoka, Japan (GRID:grid.177174.3) (ISNI:0000 0001 2242 4849)
4 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)
5 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)
6 Fukuoka Mirai Hospital, Fukuoka, Japan (GRID:grid.177174.3)
7 Seiai Rehabilitation Hospital, Onojo, Japan (GRID:grid.177174.3)
8 Japan Seafarers Relief Association Moji Ekisaikai Hospital, Kitakyushu, Japan (GRID:grid.177174.3)
9 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)