RT Journal Article
SR Electronic
T1 Smoking influences outcome in patients who had thrombolysed ischaemic stroke: the ENCHANTED study
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 395
OP 401
DO 10.1136/svn-2020-000493
VO 6
IS 3
A1 Sun, Lingli
A1 Song, Lili
A1 Yang, Jie
A1 Lindley, Richard I
A1 Robinson, Thompson
A1 Lavados, Pablo M
A1 Delcourt, Candice
A1 Arima, Hisatomi
A1 Ovbiagele, Bruce
A1 Chalmers, John
A1 Anderson, Craig S
A1 Wang, Xia
YR 2021
UL http://svn.bmj.com/content/6/3/395.abstract
AB Background and purpose 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).Methods 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).Results 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.Conclusion Smoking predicts poor functional recovery in patients who had thrombolysed AIS.Trial registration number NCT01422616.Data are available upon reasonable request. Individual deidentified participant data used in these analyses can be shared by formal request with protocol and statistical analysis plan from any qualified investigator to the Research Office of The George Institute for Global Health, Australia. A tailored dataset specific to the research question will be shared for 6 months, and the data can be only accessed by qualified statisticians for the proposed analysis.