Université Lille Nord de France, UDSL (EA 1046), Lille, France.
Eur Neurol. 2012;67(3):178-83. doi: 10.1159/000334847. Epub 2012 Jan 28.
BACKGROUND/AIMS: Thrombolysis for myocardial infarction is more effective in smokers. Our aim was to determine whether smokers treated by intravenous (i.v.) rt-PA for acute cerebral ischemia have better outcomes.
Comparison of smokers and non-smokers for baseline characteristics and month-3 outcome in patients treated by i.v. rt-PA for cerebral ischemia in Lille, France, and Belgrade, Serbia. The primary outcome was a modified Rankin scale (mRS) 0-1 or similar to the pre-stroke mRS. Secondary outcomes were an mRS 0-2 and death.
We included 459 patients (255 men; median age 65 years, interquartile range 52-76; 135 smokers). Smokers were younger (median 53 vs. 70 years, p < 0.0001) and had less severe strokes (median NIHSS 10 vs. 14, p < 0.0001). At month 3, they were more likely to have an mRS 0-1 [odds ratio (OR) 1.75; 95% confidence interval (CI) 1.17-2.62], or an mRS 0-2 (OR 2.90; 95% CI 1.86-4.52) and less likely to be dead (OR 0.28; 95% CI 0.13-0.61). Smoking was not independently associated with outcome after adjustment for case mix [adjusted OR ((adj)OR) 0.86; 95% CI 0.52-1.43].
Smoking does not independently influence the outcome in patients treated by rt-PA for cerebral ischemia. The better outcome in smokers is the consequence of differences in case mix.
背景/目的：心肌梗死患者的溶栓治疗效果在吸烟者中更为显著。我们的目的是确定急性脑缺血接受静脉（i.v.）rt-PA 治疗的吸烟者是否具有更好的结局。
比较法国里尔和塞尔维亚贝尔格莱德接受 i.v. rt-PA 治疗脑缺血的患者中吸烟者和非吸烟者的基线特征和 3 个月结局。主要结局是改良 Rankin 量表（mRS）0-1 或与基线 mRS 相似。次要结局是 mRS 0-2 和死亡。
我们纳入了 459 例患者（255 例男性；中位年龄 65 岁，四分位间距 52-76；135 例吸烟者）。吸烟者更年轻（中位数 53 岁 vs. 70 岁，p < 0.0001）且卒中更轻（中位数 NIHSS 10 分 vs. 14 分，p < 0.0001）。3 个月时，他们更可能获得 mRS 0-1 [比值比（OR）1.75；95%置信区间（CI）1.17-2.62]或 mRS 0-2（OR 2.90；95% CI 1.86-4.52），且死亡风险更低（OR 0.28；95% CI 0.13-0.61）。调整混杂因素后，吸烟与结局无相关性（调整 OR（adj.OR）0.86；95% CI 0.52-1.43）。
吸烟对接受 rt-PA 治疗脑缺血的患者结局无独立影响。吸烟者结局更好是由于混杂因素的差异所致。
