Smoking-Thrombolysis Relationship Depends on Ischemic Stroke Subtype

Xu Tong; Chunjuan Wang; Xiaoling Liao; Yuesong Pan; Hongyi Yan; Yibin Cao; Liping Liu; Huaguang Zheng; Xingquan Zhao; Chunxue Wang; Hao Li; David Wang; Yilong Wang; Yongjun Wang; Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) Investigators*

doi:10.1161/STROKEAHA.116.013124

Smoking-Thrombolysis Relationship Depends on Ischemic Stroke Subtype

Stroke. 2016 Jul;47(7):1811-6. doi: 10.1161/STROKEAHA.116.013124. Epub 2016 May 24.

Authors

Affiliations

¹ From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
² From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.). [email protected] [email protected].

PMID: 27222526
DOI: 10.1161/STROKEAHA.116.013124

Abstract

Background and purpose: The relationship between smoking and the outcome in patients received thrombolysis is undetermined. The outcome could be influenced by different stroke subtypes. This study aimed to explore whether smoking had any impact on the outcome in patients with stroke of different subtypes who received intravenous thrombolysis.

Methods: All patients who received intravenous thrombolysis within 4.5 hours after symptom onset from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) database were eligible to be entered into this analysis. Smokers were considered if they smoked at least 1 cigarette/d for >6 months before stroke. Ischemic stroke subtype was classified by using the Trial of Org 10172 in Acute Stroke Treatment criteria. Outcome measurements included post-intravenous thrombolysis symptomatic intracranial hemorrhage within 7 days, mortality, and functional independence at 90 days. The relationship between smoking and thrombolysis was analyzed by using univariate and multivariate logistic regression models.

Results: Of 1118 patients enrolled, we identified 454 smokers and 664 nonsmokers. After stratifying for ischemic stroke subtypes, multivariate analysis revealed a significant relationship between smoking and functional independence in patients with noncardioembolism stroke subtypes (large artery atherosclerosis: odds ratio [OR], 1.452; 95% confidence interval [CI], 1.053-2.264; small artery occlusion: OR, 4.275; 95% CI, 1.098-16.649; other: OR, 3.120; 95% CI, 1.162-8.373). Furthermore, smoking was specially related to lower rates of symptomatic intracranial hemorrhage (OR, 0.316; 95% CI, 0.120-0.832) and mortality (OR, 0.272; 95% CI, 0.128-0.577) in patients with large artery atherosclerosis subtype.

Conclusions: In patients treated with intravenous thrombolysis, smoking could be related to a better chance of functional independence if their subtype of stroke was noncardioembolic, and a lower risk of symptomatic intracranial hemorrhage and mortality in those with large artery atherosclerosis.

Keywords: atherosclerosis; intracranial hemorrhages; smoking; stroke; thrombolytic therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain Ischemia / drug therapy*
Female
Fibrinolytic Agents / adverse effects
Fibrinolytic Agents / therapeutic use*
Humans
Intracranial Hemorrhages / chemically induced
Male
Middle Aged
Registries
Smoking*
Stroke / drug therapy*
Thrombolytic Therapy / adverse effects
Tissue Plasminogen Activator / adverse effects
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome

Substances

Fibrinolytic Agents
Tissue Plasminogen Activator