Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

Béjot, Yannick; Jacquin, Agnès; Daubail, Benoît; Lainay, Claire; Janoura, Samer; Aboa-Éboulé, Corine; Durier, Jérôme; Giroud, Maurice

doi:10.1159/000355021

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…Interestingly, the ratio was similar to that of a recent article published by our study group, 22 although we did not use the TOAST classification to classify types of stroke. PDS was associated with 3 independent factors: age, previous TIA/ stroke, and systemic hypertension.…”

Section: Predictors Of Strokesupporting

confidence: 72%

Frequency and Predictors of Stroke After Acute Myocardial Infarction

Hachet

Guenancia

Stamboul

et al. 2014

Stroke

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Background and Purpose-Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods-Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. Results-One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced inhospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/ stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis. Finally, only 45 postdischarge strokes were recorded. Postdischarge stroke subtypes showed a more heterogeneous distribution of mechanisms. The annual rate of stroke post-AMI remained stable throughout the 10-year study period. Conclusions-The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI. It showed a marked increase in the risk of death, both during hospitalization and in the year after AMI. After hospital discharge, stroke remains a rare event and is mostly associated with high cardiovascular risk. (Stroke. 2014;45:3514-3520.)

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Section: Predictors Of Strokesupporting

confidence: 72%

Frequency and Predictors of Stroke After Acute Myocardial Infarction

Hachet

Guenancia

Stamboul

et al. 2014

Stroke

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“…In our sample, the prevalence of vascular risk factors did not differ between stroke patients with and without psychiatric premorbidity except for smoking, supporting the well-established fact that smoking is more common in psychiatric patients than in the general population 40. However, even though cigarette smoking is an established risk factor for stroke,41 data regarding the contribution of smoking to stroke severity are inconsistent 42–45. Unfortunately, we did not have information on our patients’ body mass index, which would have been valuable in light of the association of obesity and mental health, on the one hand,46 and obesity and prognosis after stroke, on the other 47–49.…”

Section: Discussionsupporting

confidence: 68%

<p>Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke</p>

Hoyer

Schmidt

Kranaster

et al. 2019

NDT

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Background and purpose The comorbidity of psychiatric disorders and cerebrovascular disease appears to be complex with underlying bidirectional influences. Hitherto, research has focused mainly on the evaluation of stroke risk in particular psychiatric disorders; only a few studies have assessed their role in the acute natural history of stroke. The aim of this study was to provide a perspective on psychiatric premorbidity and its impact on stroke severity, psychiatric complications during the initial treatment phase, and the short-term functional outcome of stroke. Patients and methods We retrospectively studied the impact of a predocumented psychiatric diagnosis (PDPD) on stroke severity, short-term functional outcome, and psychiatric complications in a sample of 798 patients consecutively admitted for acute ischemic or hemorrhagic stroke by performing a chart review. Group comparisons (PDPD vs non-PDPD) with adjustment for covariates were carried out either using multivariate analysis of variance or logistic regression analysis. Results More severe strokes (ie, mean National Institute of Health Stroke Scale score on admission 10.1±7.9 vs 7.5±7.4; F(10,796)=18.5, p <0.0001) and higher prevalence of poor outcome (73.7 vs 54.9%; OR: 2.6, standard error: 0.5, z=4.82, p <0.0001) was found in patients with a documented psychiatric diagnosis at the time of stroke, as well as a higher rate of psychiatric complications during the initial treatment phase (46.7 vs 28.9%; OR: −0.78, z=4.59, p <0.0001). Conclusion Our data have clinical implications in that they call for identification of psychiatric premorbidity or comorbidity through careful history-taking and particularly close monitoring for psychiatric complications with respect to their potentially negative impact on outcome after stroke.

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“…To address the risk reduction of all-cause death in “quitters after AF diagnosis” and the impact of quitting smoking on the severity of ischemic stroke, we added data on fatal stroke events and deaths from cerebrovascular disease as secondary outcomes. Based on previous studies, the clinical impact of smoking on the severity of stroke remains controversial and has been reported to vary in different etiologies of stroke [ 37 , 38 , 39 ]. In the present analysis, we demonstrate that not only was the risk of ischemic stroke lower, but the risks of fatal ischemic stroke and death from cerebrovascular events were also significantly lower in quitters after AF diagnosis than in current smokers.…”

Section: Discussionmentioning

confidence: 99%

Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death

Lee

Choi

Jung

et al. 2021

JCM

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Limited data are available regarding the impact of smoking cessation after atrial fibrillation (AF) diagnosis on clinical outcomes. Using the Korean National Health Insurance Service database, we included patients newly diagnosed with AF and categorized them into four groups as follows: (i) never smokers, (ii) ex-smokers, (iii) smoking cessation after AF diagnosis (“quitters”), and (iv) current smokers. The primary outcomes were incident ischemic stroke and all-cause death during follow-up. Fatal ischemic stroke and death from cerebrovascular events were evaluated as secondary outcomes. Among 97,637 patients (mean age, 61 years; mean CHA2DS2-VASc score, 2.3), 6.9% stopped smoking after AF diagnosis. The mean follow-up duration was 3.2 ± 2.0 years. After multivariable adjustment, quitters had lower risks of ischemic stroke (hazard ratio (HR), 0.702; 95% confidence interval (CI), 0.595–0.827) and all-cause death (HR, 0.842; 95% CI, 0.748–0.948) than current smokers. Quitters after AF diagnosis were associated with lower risks of fatal ischemic stroke (HR, 0.454; 95% CI, 0.287–0.718) and death from cerebrovascular events (HR, 0.664; 95% CI, 0.465–0.949) compared with current smokers. Quitting smoking may reduce the risk of ischemic stroke, the severity of ischemic stroke, and the incidence of cerebrovascular events in patients with new-onset AF.

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Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

Cited by 11 publications

References 22 publications

Frequency and Predictors of Stroke After Acute Myocardial Infarction

Frequency and Predictors of Stroke After Acute Myocardial Infarction

<p>Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke</p>

Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death

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