Affiliation:
1. Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA
2. Calgary Stroke Program, University of Calgary, Alberta, Canada
3. Brigham and Women's Hospital and VA Boston Healthcare System, Boston, MA
4. Division of Cardiology, Ronald Reagan‐UCLA Medical Center, Los Angeles, CA
Abstract
Background
Compared to those who never smoked, a paradoxical effect of smoking on reducing mortality in patients admitted with myocardial ischemia has been reported. We sought to determine if this effect was present in patients hospitalized with ischemic stroke.
Methods and Results
Using the local Get with the Guidelines‐Stroke registry, we analyzed 4305 consecutively admitted ischemic stroke patients (March 2002–December 2011). The sample was divided into smokers versus nonsmokers. The main outcome of interest was the overall inpatient mortality. Compared to nonsmokers, tobacco smokers were younger, more frequently male and presented with fewer stroke risk factors such as hypertension, hyperlipidemia, diabetes, coronary artery disease, and atrial fibrillation. Smokers also had a lower average NIH Stroke Scale (
NIHSS
) and fewer received tissue plasminogen activator (
tPA
). Patients in both groups had similar adherence to early antithrombotics, dysphagia screening prior to oral intake, and deep vein thrombosis (
DVT
) prophylaxis. Smoking was associated with lower all‐cause in‐hospital mortality (6.6% versus 12.4%; unadjusted
OR
0.46;
CI
[0.34 to 0.63];
P
<0.001). In multivariable analysis, adjusted for age, gender, ethnicity, hypertension, diabetes mellitus, hyperlipidemia,
CAD
, atrial fibrillation,
NIHSS
, and
tPA
, smoking remained independently associated with lower mortality (adjusted
OR
0.64;
CI
[0.42 to 0.96];
P
=0.03).
Conclusions
Similar to myocardial ischemia, smoking was independently associated with lower inpatient mortality in acute ischemic stroke. This effect may be due to tobacco‐induced changes in cerebrovascular vasoreactivity, or may be due in part to residual confounding. Larger, multicenter studies are needed to confirm the finding and the effect on 30‐day and 1‐year mortality.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
66 articles.
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