nad a22 4500 551414715 20181214064300.0 cr unu---uuuuu 181214e20180501xx s 000 0 eng 10.5167/uzh-159387 doi 10.1161/strokeaha.117.017976 doi (ZORA)oai:www.zora.uzh.ch:159387 610 ddc 29636423 pmid Impact of Smoking on Clinical Outcome and Recanalization After Intravenous Thrombolysis for Stroke [Elektronische Daten] [Rebekka Kurmann, Stefan T Engelter, Patrik Michel, Andreas R Luft, Susanne Wegener, Meret Branscheidt, Elissavet Eskioglou, Gaia Sirimarco, Philippe A Lyrer, Henrik Gensicke, Thomas Horvath, Urs Fischer, Marcel Arnold, Hakan Sarikaya] openAccess eu-repo BACKGROUND AND PURPOSE: The impact of smoking on prognosis after stroke is controversial. We aimed to assess the relationship between smoking status and stroke outcome after intravenous thrombolysis in a large cohort study by adjusting for potential confounders and incorporating recanalization rates. METHODS: In a prospective observational multicenter study, we analyzed baseline and outcome data of consecutive patients with acute ischemic stroke treated with intravenous thrombolysis. Using uni- and multivariable modeling, we assessed whether smoking was associated with favorable outcome (modified Rankin Scale score of 0-1) and mortality. In addition, we also measured the occurrence of symptomatic intracranial hemorrhage and recanalization of middle cerebral artery. Patients reporting active cigarette use were classified as smokers. RESULTS: Of 1865 patients, 19.8% were smokers (n=369). They were younger (mean 63.5 versus 71.3 years), less often women (56% versus 72.1%), and suffered less often from hypertension (61.3% versus 70.1%) and atrial fibrillation (22.7% versus 35.6%) when compared with nonsmokers. Favorable outcome and 3-month mortality were in favor of smokers in unadjusted analyses (45.8% versus 39.5% and 9.3% versus 15.8%, respectively), whereas symptomatic intracranial hemorrhage was comparable in both cohorts. Smoking was not associated with clinical outcome and mortality after adjusting for confounders (odds ratio, 1.20; 95% confidence interval, 0.91-1.61; P=0.197 and odds ratio, 1.08; 95% confidence interval, 0.68-1.71; P=0.755, respectively). However, smoking still independently predicted recanalization of middle cerebral artery in multivariable analyses (odds ratio, 2.68; 95% confidence interval, 1.11-6.43; P=0.028). CONCLUSIONS: Our study suggests that good outcome in smokers is mainly related to differences in baseline characteristics and not to biological effects of smoking. The higher recanalization rates in smokers, however, call for further studies. Clinic for Neurology zora Neuroscience Center Zurich zora Advanced and Specialised Nursing, Clinical Neurology, Cardiology and Cardiovascular Medicine zora Kurmann Rebekka joint author Engelter Stefan T. joint author Michel Patrik joint author Luft Andreas R. joint author Wegener Susanne joint author Branscheidt Meret joint author Eskioglou Elissavet joint author Sirimarco Gaia joint author Lyrer Philippe A. joint author Gensicke Henrik joint author Horvath Thomas joint author Fischer Urs joint author Arnold Marcel joint author Sarikaya Hakan joint author Stroke 49(5):1170-1175 https://www.zora.uzh.ch/id/eprint/159387/3/Manuscript_Smoking_Paradox_IVT_Revision_25_01_18_v3.pdf text/html WWW-Backlink auf das Repository 1 Journal Article PeerReviewed zora ZORA 856 40 https://www.zora.uzh.ch/id/eprint/159387/3/Manuscript_Smoking_Paradox_IVT_Revision_25_01_18_v3.pdf text/html WWW-Backlink auf das Repository ZORA 700 1- Kurmann Rebekka joint author ZORA 700 1- Engelter Stefan T. joint author ZORA 700 1- Michel Patrik joint author ZORA 700 1- Luft Andreas R. joint author ZORA 700 1- Wegener Susanne joint author ZORA 700 1- Branscheidt Meret joint author ZORA 700 1- Eskioglou Elissavet joint author ZORA 700 1- Sirimarco Gaia joint author ZORA 700 1- Lyrer Philippe A. joint author ZORA 700 1- Gensicke Henrik joint author ZORA 700 1- Horvath Thomas joint author ZORA 700 1- Fischer Urs joint author ZORA 700 1- Arnold Marcel joint author ZORA 700 1- Sarikaya Hakan joint author ZORA 773 0- Stroke 49(5):1170-1175 BK010053 XK010053 XK010000 ZORA ZORA ZORA Journal Article openAccess