title: Influence of differences in case mix on the better outcome of smokers after intravenous thrombolysis for acute cerebral ischemia.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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].
  
  
  CONCLUSIONS
  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.
authors.affiliation: Université Lille Nord de France, UDSL (EA 1046), Lille, France.
authors.forename: Solène
authors.initials: S
authors.lastname: Moulin
authors.forename: Visnja
authors.initials: V
authors.lastname: Padjen-Bogosavljevic
authors.forename: Aurélie
authors.initials: A
authors.lastname: Marichal
authors.forename: Charlotte
authors.initials: C
authors.lastname: Cordonnier
authors.forename: Dejana R
authors.initials: DR
authors.lastname: Jovanovic
authors.forename: Sophie
authors.initials: S
authors.lastname: Gautier
authors.forename: Hilde
authors.initials: H
authors.lastname: Hénon
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Beslac-Bumbasirevic
authors.forename: Régis
authors.initials: R
authors.lastname: Bordet
authors.forename: Didier
authors.initials: D
authors.lastname: Leys
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D003953:Diagnosis-Related Groups; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012907:Smoking; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator