title: Smoking-Thrombolysis Relationship Depends on Ischemic Stroke Subtype.
abstract: The relationship between smoking and the outcome in patients received thrombolysis is undetermined. The outcome could be influenced by different stroke subtypes. This study aimed to explore whether smoking had any impact on the outcome in patients with stroke of different subtypes who received intravenous thrombolysis.
  
  
  
  All patients who received intravenous thrombolysis within 4.5 hours after symptom onset from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) database were eligible to be entered into this analysis. Smokers were considered if they smoked at least 1 cigarette/d for >6 months before stroke. Ischemic stroke subtype was classified by using the Trial of Org 10172 in Acute Stroke Treatment criteria. Outcome measurements included post-intravenous thrombolysis symptomatic intracranial hemorrhage within 7 days, mortality, and functional independence at 90 days. The relationship between smoking and thrombolysis was analyzed by using univariate and multivariate logistic regression models.
  
  
  
  Of 1118 patients enrolled, we identified 454 smokers and 664 nonsmokers. After stratifying for ischemic stroke subtypes, multivariate analysis revealed a significant relationship between smoking and functional independence in patients with noncardioembolism stroke subtypes (large artery atherosclerosis: odds ratio [OR], 1.452; 95% confidence interval [CI], 1.053-2.264; small artery occlusion: OR, 4.275; 95% CI, 1.098-16.649; other: OR, 3.120; 95% CI, 1.162-8.373). Furthermore, smoking was specially related to lower rates of symptomatic intracranial hemorrhage (OR, 0.316; 95% CI, 0.120-0.832) and mortality (OR, 0.272; 95% CI, 0.128-0.577) in patients with large artery atherosclerosis subtype.
  
  
  
  In patients treated with intravenous thrombolysis, smoking could be related to a better chance of functional independence if their subtype of stroke was noncardioembolic, and a lower risk of symptomatic intracranial hemorrhage and mortality in those with large artery atherosclerosis.
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Xu
authors.initials: X
authors.lastname: Tong
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Chunjuan
authors.initials: C
authors.lastname: Wang
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Liao
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Hongyi
authors.initials: H
authors.lastname: Yan
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Yibin
authors.initials: Y
authors.lastname: Cao
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Huaguang
authors.initials: H
authors.lastname: Zheng
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.). yilong528@gmail.com yongjunwang1962@gmail.com.
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.). yilong528@gmail.com yongjunwang1962@gmail.com.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D012042:Registries; D012907:Smoking; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: atherosclerosis; intracranial hemorrhages; smoking; stroke; thrombolytic therapy