Improved outcome after atherosclerotic stroke in male smoker.

Background: Smoking is a well-known risk factor for ischaemic stroke or transient ischaemic attack. Paradoxically, smokers have been reported to have better prognosis after myocardial infarction when compared to nonsmokers. This study examined the independent effect of smoking status on long-term prognosis after ischaemic stroke in male patients.
Methods: A total 476 male patients with acute cerebral infarction within the middle cerebral artery territory were reviewed. Baseline characteristics and long-term prognosis were compared among smokers, ex-smokers, and nonsmokers.
Results: Although the baseline severity of stroke did not differ among the groups, poor long-term outcome (Barthel index<60 or modified Rankin score>3) at 6 months after ischaemic stroke was more frequently observed in nonsmokers than in smokers (P=0.013); the outcome for ex-smokers was intermediate. After adjustment for age and other variables, current smoking was negatively correlated to poor long-term outcome (odds ratio, 0.286; 95% confidence interval, 0.119-0.686; P=0.005). On subgroup analysis, the impact of smoking on stroke prognosis was significant only in younger patients (<65 years of age) and those with atherosclerotic stroke.
Conclusions: There was a strong independent correlation between smoking status and long-term outcome in patients with ischaemic stroke. Further studies about the impact of smoking habit on stroke outcome depending on the characteristics of patients (ie. age and stroke subtype) are needed.