Smoking influences outcome in patients who had thrombolysed ischaemic stroke: the ENCHANTED study
Journal
Stroke and Vascular Neurology
ISSN
2059-8688
2059-8696
Date Issued
2021
Author(s)
Lingli Sun
Lili Song
Jie Yang
Richard I Lindley
Thompson Robinson
Pablo M Lavados
Candice Delcourt
Hisatomi Arima
Bruce Ovbiagele
John Chalmers
Craig S Anderson
Xia Wang
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Background and purpose</jats:title><jats:p>As studies vary in defining the prognostic significance of smoking in acute ischaemic stroke (AIS), we aimed to determine the relation of smoking and key outcomes in patient participants who had thrombolysed AIS of the international quasi-factorial randomised Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Post-hoc analyses of ENCHANTED, an international quasi-factorial randomised evaluation of intravenous alteplase-dose comparison and levels of blood pressure control in patients who had thrombolysed AIS. Multivariable logistic regression models with inverse probability of treatment weighting (IPTW) propensity scores were used to determine associations of self-reported smoking status and clinical outcomes, according to 90-day modified Rankin Scale (mRS) scores and symptomatic intracerebral haemorrhage (sICH).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 4540 patients who had an AIS, there were 1008 (22.2%) current smokers who were younger and predominantly male, with more comorbidities of hypertension, coronary artery disease, atrial fibrillation and diabetes mellitus, and greater baseline neurological impairment, compared with non-smokers. In univariate analysis, current smokers had a higher likelihood of a favourable shift in mRS scores (OR 0.88, 95% CI 0.77 to 0.99; p=0.038) but this association reversed in a fully adjusted model with IPTW (adjusted OR 1.15, 95% CI 1.04 to 1.28; p=0.009). A similar trend was also apparent for dichotomised poor outcome (mRS scores 2–6: OR 1.18, 95% CI 1.05 to 1.33; p=0.007), but not with the risk of sICH across standard criteria.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Smoking predicts poor functional recovery in patients who had thrombolysed AIS.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT01422616">NCT01422616</jats:ext-link>.</jats:p></jats:sec>
Cite this document
Sun, L., Song, L., Yang, J., Lindley, R. I., Robinson, T., Lavados, P. M., Delcourt, C., Arima, H., Ovbiagele, B., Chalmers, J., Anderson, C. S., & Wang, X. (2021). Smoking influences outcome in patients who had thrombolysed ischaemic stroke: The ENCHANTED study. Stroke and Vascular Neurology, 6(3), e000493. https://doi.org/10.1136/svn-2020-000493
Subjects
stroke
;
thrombolysis
;
brain ischemia
;
fibrinolytic agents
;
humans
;
ischemic stroke
;
male
;
smoking
;
stroke
;
treatment outcome
;
acetylsalicylic acid
;
alteplase
;
anticoagulant agent
;
heparin
;
hydroxymethylglutaryl coenzyme a reductase inhibitor
;
warfarin
;
fibrinolytic agent
;
adult
;
article
;
atrial fibrillation
;
blood pressure regulation
;
brain hemorrhage
;
clinical outcome
;
comorbidity assessment
;
coronary artery disease
;
current smoker
;
diabetes mellitus
;
drug megadose
;
female
;
fibrinolytic therapy
;
human
;
hypertension
;
ischemic stroke
;
low drug dose
;
major clinical study
;
male
;
post hoc analysis
;
rankin scale
;
secondary analysis
;
sex difference
;
smoking
;
stroke patient
;
brain ischemia
;
cerebrovascular accident
;
smoking
;
treatment outcome