Effect of smoking status on clinical outcomes after reperfusion therapy for acute ischemic stroke

Abstract

Abstract Although smoking has detrimental effects on the cardiovascular system, some studies have reported better clinical outcomes in smokers than in nonsmokers after thrombolysis for ischemic stroke, known as the smoking paradox. 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. We divided the 1,148 study patients 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 by logistic regression analysis and propensity score-matched analysis. Of the participants, 231 (20.1%) were current smokers. After adjusting for potential confounders, the odds ratios (ORs) of favorable outcomes 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 either. Given that current smoking was not associated with better outcomes after reperfusion therapy, smoking cessation is strongly recommended.