Smoking Status and Functional Outcomes After Acute Ischemic Stroke

Matsuo, Ryu; Ago, Tetsuro; Kiyuna, Fumi; Sato, Noriko; Nakamura, Kuniyuki; Kuroda, Junya; Wakisaka, Yoshinobu; Kitazono, Takanari

doi:10.1161/strokeaha.119.027230

Cited by 42 publications

(43 citation statements)

References 27 publications

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“…On average, smoking may cause stroke people to get stroke 11 years earlier than nonsmokers, resulting in longer periods of disability and suffering. Smoking has also been associated with an elevated risk of unfavorable functional outcomes at 3 months after acute ischemic stroke [66]. Our analysis did not reveal a significant association between smoking and prognosis in posterior circulation stroke patients after MT.…”

Section: Discussioncontrasting

confidence: 62%

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

Xun

Ruan

et al. 2020

Cerebrovasc Dis

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Background: Posterior circulation stroke is characterized by poor prognosis because its optimal thrombolysis “time window” is always missed. After mechanical thrombectomy (MT), the recanalization rate of posterior circulation obstruction is significantly increased, but prognosis remains poor. To best manage patients, prognostic factors are needed to inform MT triaging after posterior circulation stroke. Methods: A systematic literature search was done for the period through April 2020. Studies included those with posterior circulation stroke cases that underwent MT. The primary outcome measure in this study was the modified Rankin Scale on day 90. Results: No outcome differences were found in gender, atrial fibrillation, smoking, and coronary artery disease (OR = 1.07, 95% CI: 0.90–1.28; OR = 1.02, 95% CI: 0.82–1.26; OR = 1.26, 95% CI: 0.94–1.68; and OR = 0.84, 95% CI: 0.58–1.22, respectively). Hypertension, diabetes mellitus, and previous stroke correlated with poorer prognosis (OR = 0.61, 95% CI: 0.48–0.77; OR = 0.60, 95% CI: 0.50–0.73; and OR = 0.74, 95% CI: 0.55–0.99, respectively). However, hyperlipidemia correlated with better prognosis (OR = 1.28, 95% CI: 1.04–1.58). Conclusion: Our analysis indicates that hypertension, diabetes mellitus, or previous stroke correlate with poorer outcomes. Intriguingly, hyperlipidemia correlates with better prognosis. These factors may help inform triage decisions when considering MT for posterior circulation stroke patients. However, large, multicenter, randomized controlled trials are needed to validate these observations.

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Section: Discussioncontrasting

confidence: 62%

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

Xun

Ruan

et al. 2020

Cerebrovasc Dis

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“…Similar results were reported recently in the Taiwan Stroke Registry, which included approximately 89,000 subacute stroke cases [ 7 ]. This highlights the importance of the so-called index-event-bias [ 16 , 17 ] of smokers due to their lower clinical risk profiles, particularly with respect to age.…”

Section: Discussionmentioning

confidence: 99%

The smoking paradox in ischemic stroke patients treated with intra-arterial thrombolysis in combination with mechanical thrombectomy–VISTA-Endovascular

et al. 2021

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Background The smoking-paradox of a better outcome in ischemic stroke patients who smoke may be due to increased efficacy of thrombolysis. We investigated the effect of smoking on outcome following endovascular therapy (EVT) with mechanical thrombectomy alone versus in combination with intra-arterial (IA-) thrombolysis. Methods The primary endpoint was defined by three-month modified Rankin Scale (mRS). We performed a generalized linear model and reported relative risks (RR) for smoking (adjustment for age, sex, hypertension, atrial fibrillation, stroke severity, time to EVT) in patient data stemming from the Virtual International Stroke Trials Archive—Endovascular database. Results Among 1,497 patients, 740(49.4%) were randomized to EVT; among EVT patients, 524(35.0%) received mechanical thrombectomy alone and 216(14.4%) received it in combination with IA-thrombolysis. Smokers (N = 396) had lower mRS scores (mean 2.9 vs. 3.2; p = 0.02) and mortality rates (10% vs. 17.3%; p<0.001) in univariate analysis. In all patients and in patients treated with mechanical thrombectomy alone, smoking had no effect on outcome in regression analyses. In patients who received IA-thrombolysis (N = 216;14%), smoking had an adjusted RR of 1.65 for an mRS≤1 (95%CI 0.77–3.55). Treatment with IA-thrombolysis itself led to reduced RR for favorable outcome (adjusted RR 0.30); interaction analysis of IA-thrombolysis and smoking revealed that non-smokers with IA-thrombolysis had mRS≤2 in 47 cases (30%, adjusted RR 0.53 [0.41–0.69]) while smokers with IA-thrombolysis had mRS≤2 in 23 cases (38%, adjusted RR 0.61 [0.42–0.87]). Conclusions Smokers had no clear clinical benefit from EVT that incorporates IA-thrombolysis.

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“…The presence of multiple risk factors was found to be the other important predictor of the occurrence of complications and functional outcome as assessed by multivariate logistic regression analysis. There are several studies which have shown that the presence of risk factors like hypertension, diabetes, smoking, and even aging all portend a poorer prognosis in stroke [16][17][18][19][20][21][22][23][24][25][70][71][72][73][74]. Most of our patients had multiple risk factors, suggesting that the presence of more than one risk factor worsens prognosis in stroke.…”

Section: Discussionmentioning

confidence: 63%

“…Most of the traditional risk factors for stroke such as diabetes, hypertension, smoking, and heart disease are prevalent in this region [2]. These aforesaid associated co-morbidities hinder post-stroke recovery and increase complications after stroke [16][17][18][19][20][21][22][23][24][25]. However, several complications can arise as a direct result of the brain-insult itself, from the ensuing disability or immobility, or even from stroke-related treatments [26].…”

Section: Introductionmentioning

confidence: 99%

Determinants of complications in ﬁrst ever acute stroke patients: a prospective observational study from India

2021

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Background and Aims: Post-stroke complications can lead to frequent and major causes of death in the early phases after an acute stroke. Aims of the present study were to determine the association of several risk factors with the occurrence of poststroke complications, the predictors for the development of complications, and to evaluate how these complications affected the overall prognosis among subjects with the first ever acute stroke. This study is the pioneer study of this kind from Eastern India. Previous national and international studies on this lack uniformity in their results probably because of the following reasons: no standard definitions for complications following the stroke, varied follow-up periods ranging from 1 week to 30 months, type and severity of stroke affecting the incidence, and finally, the demographic variables. Methods: This was an observational, prospective study, in which a total of 521 adult male and female patients who had a first-ever acute stroke, aged between 12 years to 75 years were enrolled over a period of 2 years (September 2016 to September 2018), admitted in Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, India. Patients with first ever acute stroke were studied for post-stroke complications (predefined with standard criteria) during the hospital stay at Bangur Institute of Neurosciences (BIN), Kolkata, India, and their association with risk factors, severity of stroke (National Institutes of Health Stroke Scale Score, NIHSS), length of hospital stay (in days) and outcome (Modified Rankin Scale, MRS) were assessed. Results: A total of screened 498 patients who were admitted at Bangur Institute of Neurosciences (BIN), Kolkata, India, with first ever acute stroke were recruited. The mean age was 61.02 years (range 23-75 years), the majority being male (n = 307; 61.6%). Post-stroke complication during hospital stay was documented in 270 patients (54.2%)(males and females combined). In logistic regression analysis, multiple risk factors (OR, 1.571; 95% CI, 1.084-2.278; P-0.017), severity of stroke (National Institutes of Health Stroke Scale Score, NIHSS) (OR, 1.425; 95% CI, 1.027-1.976; P-0.034) and length of hospital stay (in days) (OR, 3.565; 95% CI, 2.029-6.264; P < 0.0001) were the most robust predictors of occurrence of complications. The independent predictors of poor outcome in subjects with complications were: chest infection (OR, 2.07; 95% CI, 1.006-4.26; P = 0.048), bedsores (OR, 2.26; 95% CI, 1.03-4.94; P-0.042), and seizures (OR, 5.072; 95% CI, 1.08-23.79; P-0.039). Conclusion: In our study, the most independent predictors of complications were severity of stroke and length of hospital stay. This observation might help clinicians in taking appropriate measures towards preventing post-stroke complications and thereby improving outcome following a stroke.

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Smoking Status and Functional Outcomes After Acute Ischemic Stroke

Cited by 42 publications

References 27 publications

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

The smoking paradox in ischemic stroke patients treated with intra-arterial thrombolysis in combination with mechanical thrombectomy–VISTA-Endovascular

Determinants of complications in ﬁrst ever acute stroke patients: a prospective observational study from India

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