Paradoxical Association of Smoking With In‐Hospital Mortality Among Patients Admitted With Acute Ischemic Stroke

Ali, Syed F.; Smith, Eric E.; Bhatt, Deepak L.; Fonarow, Gregg C.; Schwamm, Lee H

doi:10.1161/jaha.113.000171

Cited by 69 publications

(66 citation statements)

References 36 publications

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“…[3][4][5][6][7][8][9][10] In addition, most of the existing studies have not been population based and have often been conducted in specialized units which raise concerns about the generalizability of the findings. There is consequently a need for large-scale studies on unselected patients in order better to comprehend the impact of lifestyle on stroke outcomes, including stroke severity, the risk of important medical complications, and mortality in acute stroke care settings.…”

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confidence: 99%

Lifestyle Factors and Early Clinical Outcome in Patients With Acute Stroke

Ingeman

Andersen

Thomsen

et al. 2017

Stroke

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2 ), smoking habits, and alcohol intake, which were grouped (healthy, moderately healthy, moderately unhealthy, and unhealthy). The associations between lifestyle and outcomes were examined using multivariable regression. Results-A total of 18.3% had a severe stroke, 7.8% pneumonia, 12.5% urinary tract infection, and 9.9% died within 30 days. The association between lifestyle, stroke severity, and mortality, respectively, differed according to sex. However, underweight may be a particular concern being associated with an increased risk of adverse outcomes among both sexes.

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confidence: 99%

Lifestyle Factors and Early Clinical Outcome in Patients With Acute Stroke

Ingeman

Andersen

Thomsen

et al. 2017

Stroke

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“…Some prior studies, however, have suggested the existence of a “smoker's paradox,” implying that the outcomes of acute myocardial infarction (MI) may be more favorable in smokers than in nonsmokers 2, 3, 4, 5, 6. More recently, smoking has also been shown to be associated with lower in‐hospital mortality in patients with acute ischemic stroke, acute heart failure, and cardiac arrest 7, 8, 9, 10…”

Section: Introductionmentioning

confidence: 99%

Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Gupta

Kolte

Khera

et al. 2016

JAHA

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BackgroundPrior studies have found that smokers undergoing thrombolytic therapy for ST‐segment elevation myocardial infarction have lower in‐hospital mortality than nonsmokers, a phenomenon called the “smoker's paradox.” Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention.Methods and ResultsWe used the 2003–2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction. Multivariable logistic regression was used to compare in‐hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in‐hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31–0.33, P<0.001). Although the association between smoking and lower in‐hospital mortality was partly attenuated after baseline risk adjustment, a significant residual association remained (adjusted odds ratio 0.60, 95% CI 0.58–0.62, P<0.001). This association largely persisted in age‐stratified analyses. Smoking status was also associated with shorter average length of stay (3.5 versus 4.5 days, P<0.001) and lower incidence of postprocedure hemorrhage (4.2% versus 6.1%; adjusted odds ratio 0.81, 95% CI 0.80–0.83, P<0.001) and in‐hospital cardiac arrest (1.3% versus 2.1%; adjusted OR 0.78, 95% CI 0.76–0.81, P<0.001).ConclusionsIn this nationwide cohort of patients undergoing primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction, we observed significantly lower risk‐adjusted in‐hospital mortality in smokers, suggesting that the smoker's paradox also applies to ST‐segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

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“…2013]), the hypothesis that not smoking may cause some disadvantage is obviously untenable. It seems probable, instead, that the patients who can smoke are those in better health conditions or, vice versa, that the most compromised and elderly patients avoid smoking.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of carotid and vertebral ultrasound in ischemic stroke patients

et al. 2016

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ObjectivesThe ultrasound investigation of carotid and vertebral arteries is routinely performed in stroke patients to determine the etiopathogenetic classification and possible need of revascularization. However, the medium and long‐term prognostic implications of carotid and vertebral ultrasound in ischemic stroke patients are not yet known.MethodsThis study included 309 ischemic stroke patients (mean age 76.3; 160 men). They all had undergone carotid and vertebral ultrasound (carotid stenoses were measured according to the European Carotid Surgery Trial [ECST] method). After a median interval of 9.4 months, a telephone follow‐up was performed to determine their outcome. Dependency or death (modified Rankin scale‐mRS >2) and all cause mortality were the study end‐points.ResultsAt follow‐up, 158 patients had a mRS >2. In multivariate analysis, of 13 variables univariately predictive of dependency or death, only National Institutes of Health Stroke Scale (NIHSS) score (P < 0.0001), age (P < 0.0001) and ipsi‐ or contralateral carotid stenosis ≥60% (O.R. 3.5, 95% C.I. 1.5–8.6, P = 0.006) remained associated with a mRS >2. Sixty‐nine patients had died. In a Cox proportional hazards regression, of 10 variables univariately predictive of mortality, only NIHSS score (P < 0.0001), age (P = 0.003), total anterior circulation syndrome (P = 0.004), vertebral Doppler abnormalities (O.R. 2.2, 95% C.I. 1.3–3.6, P = 0.006), male sex (P = 0.02), and hypercholesterolemia (P = 0.04, inverse relationship) remained associated with mortality.ConclusionsIn stroke patients, carotid stenoses ≥60%, ipsi‐ or contralateral to cerebral lesions, were associated with an increased medium and long‐term probability of dependency or death, and abnormalities of vertebrobasilar flow were a significant indicator of death risk, independent of stroke severity and age.

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Paradoxical Association of Smoking With In‐Hospital Mortality Among Patients Admitted With Acute Ischemic Stroke

Cited by 69 publications

References 36 publications

Lifestyle Factors and Early Clinical Outcome in Patients With Acute Stroke

Lifestyle Factors and Early Clinical Outcome in Patients With Acute Stroke

Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Prognostic significance of carotid and vertebral ultrasound in ischemic stroke patients

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