Impact of Stroke Severity on the Smoking Paradox in Patients Treated with Intravenous Thrombolysis.

IF 2 4区医学 Q3 CLINICAL NEUROLOGY Current neurovascular research Pub Date : 2022-01-01 DOI:10.2174/1567202619666220530092614

Peng Zhang, Zhen-Ni Guo, Xiu-Li Yan, Fu-Liang Zhang, Yi Yang

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Abstract

Objective: To our knowledge, no previous studies have investigated the impact of stroke severity on the smoking paradox after intravenous thrombolysis (IVT). We aimed to explore the contribution of stroke severity to the association between smoking and stroke prognosis after IVT.

Methods: We enrolled consecutive patients who received IVT within 4.5 hours from stroke onset. A logistic regression model was used to estimate the unadjusted and adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) for poor functional outcome and mortality at 3 months.

Results: Among patients with moderate stroke, smokers experienced a lower risk of 3-month poor outcomes than non-smokers (33.0% vs. 44.4%, unadjusted OR: 0.616; 95% CI: 0.402-0.945). However, among those with severe stroke, smokers had a higher risk of 3-month poor outcomes than non-smokers (81.6% vs. 55.9%, unadjusted OR: 3.496; 95% CI: 1.207-10.127). After adjustment, the negative correlation between smoking and 3-month poor outcome following IVT lost statistical significance in patients with moderate stroke (OR: 0.677 [95% CI: 0.418-1.097]). However, smoking remained a risk factor for 3-month poor outcomes in patients with severe stroke (OR: 4.216 [95% CI: 1.236-14.385]). We also observed a significant interaction between smoking and stroke severity with regard to the risk of poor functional outcomes (p=0.023). However, no such interaction influenced mortality (p=0.901).

Conclusion: Stroke severity affects the association between smoking and 3-month clinical functional outcomes following IVT.

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脑卒中严重程度对静脉溶栓患者吸烟悖论的影响。

目的:据我们所知，目前尚无研究探讨脑卒中严重程度对静脉溶栓后吸烟悖论的影响。我们的目的是探讨卒中严重程度对吸烟与IVT后卒中预后之间关系的贡献。方法:我们招募了在卒中发生后4.5小时内接受IVT治疗的连续患者。使用逻辑回归模型估计未调整和调整的优势比(ORs)及其95%置信区间(ci)，用于3个月时不良功能结局和死亡率。结果:在中度卒中患者中，吸烟者3个月不良预后的风险低于不吸烟者(33.0% vs. 44.4%，未经调整OR: 0.616;95% ci: 0.402-0.945)。然而，在严重中风患者中，吸烟者3个月不良预后的风险高于非吸烟者(81.6% vs. 55.9%，未经调整OR: 3.496;95% ci: 1.207-10.127)。调整后，中度脑卒中患者吸烟与IVT术后3个月不良预后的负相关无统计学意义(OR: 0.677 [95% CI: 0.418-1.097])。然而，吸烟仍然是严重脑卒中患者3个月预后不良的危险因素(OR: 4.216 [95% CI: 1.236-14.385])。我们还观察到吸烟与卒中严重程度之间在功能不良结局风险方面存在显著的相互作用(p=0.023)。然而，这种相互作用对死亡率没有影响(p=0.901)。结论:卒中严重程度影响吸烟与IVT术后3个月临床功能预后之间的关系。

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来源期刊

Current neurovascular research 医学-临床神经学

CiteScore

3.80

自引率

9.50%

发文量

审稿时长

3 months

期刊介绍： Current Neurovascular Research provides a cross platform for the publication of scientifically rigorous research that addresses disease mechanisms of both neuronal and vascular origins in neuroscience. The journal serves as an international forum publishing novel and original work as well as timely neuroscience research articles, full-length/mini reviews in the disciplines of cell developmental disorders, plasticity, and degeneration that bridges the gap between basic science research and clinical discovery. Current Neurovascular Research emphasizes the elucidation of disease mechanisms, both cellular and molecular, which can impact the development of unique therapeutic strategies for neuronal and vascular disorders.