Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China.
China National Clinical Research Center for Neurological Diseases Beijing China.
J Am Heart Assoc. 2023 Aug 15;12(16):e029963. doi: 10.1161/JAHA.123.029963. Epub 2023 Aug 7.
Background Smoking is a well-established risk factor for the development of acute ischemic stroke (AIS). However, the "smoker's paradox" suggests that it is associated with favorable clinical outcomes following stroke. We aimed to reevaluate the association between smoking and in-hospital outcomes in patients with AIS in contemporary practice. Methods and Results A total of 649 610 inpatients with AIS from 1476 participating hospitals in the Chinese Stroke Center Alliance were included. In-hospital outcomes measurement included all-cause mortality, discharge against medical advice, and complications. Multivariable logistic regression models adjusting for baseline characteristics, clinical profiles at presentation, and in-hospital management were used to evaluate the association between smoking and in-hospital outcomes. A propensity score-matched analysis was also conducted. Of these patients with AIS, 36.8% (n=238 912) were smokers. Smokers were younger, had fewer comorbidities, and had slightly lower rates of adverse in-hospital outcomes than nonsmokers (all-cause death or discharge against medical advice: 6.0% versus 6.1%; in-hospital complications: 14.5% versus 15.1%). Multivariable analysis revealed that smoking was associated with higher risk of adverse in-hospital outcomes (all-cause death or discharge against medical advice: odds ratio [OR], 1.05 [95% CI, 1.02-1.08]; <0.001; complications: OR, 1.06 [95% CI, 1.04-1.08]; <0.001). The excess risk of adverse in-hospital outcomes remained in smoking patients with AIS after propensity score-matching analysis (all-cause death or discharge against medical advice: OR, 1.04 [95% CI, 1.00-1.08]; =0.034; complications: OR, 1.05 [95% CI, 1.03-1.08]; <0.001). Conclusions Smoking was associated with increased risk of adverse in-hospital outcomes among patients with AIS in contemporary practice, reinforcing the importance of smoking cessation in patients with AIS.
吸烟是急性缺血性脑卒中（AIS）发展的一个既定危险因素。然而，“吸烟者悖论”表明，它与脑卒中后有利的临床结局有关。我们旨在重新评估在当代实践中，吸烟与 AIS 患者住院期间结局的关系。
共纳入来自中国卒中中心联盟的 1476 家参与医院的 649610 例 AIS 住院患者。住院期间结局的测量包括全因死亡率、出院时违背医嘱和并发症。采用多变量逻辑回归模型，根据基线特征、就诊时的临床特征和住院期间的管理调整，评估吸烟与住院期间结局的关系。还进行了倾向评分匹配分析。在这些 AIS 患者中，36.8%（n=238912）为吸烟者。吸烟者年龄较小，合并症较少，住院期间不良结局的发生率略低于非吸烟者（全因死亡或出院时违背医嘱：6.0%比 6.1%；住院并发症：14.5%比 15.1%）。多变量分析显示，吸烟与住院期间不良结局风险增加相关（全因死亡或出院时违背医嘱：比值比[OR]，1.05[95%置信区间，1.02-1.08]；<0.001；并发症：OR，1.06[95%置信区间，1.04-1.08]；<0.001）。在倾向评分匹配分析后，吸烟的 AIS 患者仍存在住院期间不良结局的风险增加（全因死亡或出院时违背医嘱：OR，1.04[95%置信区间，1.00-1.08]；=0.034；并发症：OR，1.05[95%置信区间，1.03-1.08]；<0.001）。
在当代实践中，吸烟与 AIS 患者住院期间不良结局风险增加相关，这强调了在 AIS 患者中戒烟的重要性。
