Association between Smoking and Functional Outcome in Acute Ischemic Stroke Population Treated with Tissue Plasminogen Activator

Association between Smoking and Functional Outcome in Acute Ischemic Stroke Population Treated with Tissue Plasminogen Activator

Iretioluwa Ajani ¹ , Oluyemi Rotimi ¹ , Olubunmi Kuku ¹ , Ndukwe Kalu ¹ , Olakunle Oni ¹ , Nwabueze Christian ¹ ,Thomas Nathaniel ² , Shimin Zheng ^1*

¹ Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614

² Department of Neurology, Department of Pharmacology, Physiology & Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208

*Sponsoring faculty

Background

The effect of smoking on outcome in acute ischemic stroke patients treated with tissue plasminogen activator (TPA) is debatable. Based on the hypothesis that smokers may have more effective thrombolysis with TPA. Some clinical studies have demonstrated a favorable outcome while others have seen worse prognosis or no effect at all. This study seeks to determine the association between smoking and functional improvement in TPA treated and non-treated patients.

Methods

We analyzed data from the Greenville Health System (GHS) stroke registry on stroke patients between January 2010 and December 2013. Patients were divided into two groups: those treated with TPA and those not treated with TPA but presenting within 4.5 hours. Logistic regression analysis was conducted to assess if smoking was associated with improvement in ambulation.

Results

Of 1,446 patients, 595 (41.15 %) were treated with TPA (181 smokers (30.42%), 414 non-smokers (69.58 %) and 851 (58.85%) not treated with TPA (198 smokers (23.27 %), 653 non-smokers (76.73 %). In the multiple logistic models, smoking was not independently associated with favorable outcome in patients treated with TPA (OR = 0.84; 95% CI = 0.54 – 1.33; P = 0.46) and those not treated with TPA (OR = 0.96; 95% CI = 0.64 – 1.44; P-value = 0.85) though the bivariate models showed significant association.

Conclusion

There is no association between smoking and functional outcome in stroke patients regardless of TPA treatment. The effect of smoking on outcome in acute ischemic stroke patients treated with tissue plasminogen activator (TPA) is however stronger than those not treated with TPA.