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. 2024 Jan-Dec:30:10760296241246264.
doi: 10.1177/10760296241246264.

Risk Factors Associated With Exclusion of Obese Patients Ischemic Stroke With a History of Smoking From Thrombolysis Therapy

Philip C Brewer  1 , Dami T Ojo  1 , Philip X Broughton  1 , Adebobola Imeh-Nathaniel  2 , Samuel Imeh-Nathaniel  2 , Thomas I Nathaniel  1
Affiliations

Risk Factors Associated With Exclusion of Obese Patients Ischemic Stroke With a History of Smoking From Thrombolysis Therapy

Philip C Brewer et al. Clin Appl Thromb Hemost. 2024 Jan-Dec.

Abstract

The objective of this study is to determine risk factors that may contribute to exclusion decision from recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke (AIS) with a combined current or history of smoking and obesity. This study was conducted on data from 5469 patients with AIS collected from a regional stroke registry. Risk factors associated with inclusion or exclusion from rtPA were determined using multivariate logistic regression analysis. The adjusted odds ratios and 95% confidence interval for each risk factor were used to predict the increasing odds of an association of a specific risk factor with exclusion from rtPA. In the adjusted analysis, obese patients with AIS with a history of smoking (current and previous) excluded from rtPA were more likely to present with carotid artery stenosis (OR = 0.069, 95% CI 0.011-0.442), diabetes (OR = 0.604, 95% CI 0.366-0.997), higher total cholesterol (OR = 0.975, 95% CI 0.956-0.995), and history of alcohol use (OR = 0.438, 95% CI 0.232-0.828). Higher NIHSS score (OR = 1.051, 95% CI 1.017-1.086), higher triglycerides (OR = 1.004, 95% CI 1.001-1.006), and higher high-density lipoprotein (OR = 1.028, 95% CI 1.000-1.057) were associated with the inclusion for rtPA. Our findings reveal specific risk factors that contribute to the exclusion of patients with AIS with a combined effect of smoking and obesity from rtPA. These findings suggest the need to develop management strategies to improve the use of rtPA for obese patients with AIS with a history of smoking.

Keywords: acute ischemic stroke; obesity; risk factors; rtPA; smoking.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
ROC curve associated with prediction of risk factors of patients with ischemic stroke that were included or excluded from rtPA for the whole stroke population. Higher AUC values in ROC analysis indicate better discrimination of the score for the measured outcome. Classification table (overall correctly classified percentage  =  67.5%) and area under the ROC curve (AUROC  =  0.744 [95% CI 0.744-0.762]) were applied to check model fitness. Abbreviations: AUC, area under the curve; AUROC, area under the ROC; ROC, receiver operating characteristic; rtPA, recombinant tissue plasminogen activator.
Figure 2.
Figure 2.
ROC curve associated with prediction of risk factors associated with inclusion or exclusion from rtPA in obese patients with AIS with a history of smoking. Higher AUC values in ROC analysis indicate better discrimination of the score for the measured outcome. Classification table (overall correctly classified percentage  =  63.3%) and area under the ROC curve (AUROC  =  0.726 [95% CI 0.677-0.774]) were applied to check model fitness. Abbreviations: AIS, acute ischemic stroke; AUC, area under the curve; AUROC, area under the ROC; ROC, receiver operating characteristic; rtPA, recombinant tissue plasminogen activator.
Figure 3.
Figure 3.
ROC curve associated with prediction of risk factors of patients with ischemic stroke that were included or excluded from rtPA in patients with AIS with a history of smoking. Higher AUC values in ROC analysis indicate better discrimination of the score for the measured outcome. Classification table (overall correctly classified percentage  =  66.2%) and area under the ROC curve [AUROC  =  0.733 (95% CI 0.700-0.767])were applied to check model fitness. Abbreviations: AIS, acute ischemic stroke; AUC, area under the curve; AUROC, area under the ROC; ROC, receiver operating characteristic; rtPA, recombinant tissue plasminogen activator.
Figure 4.
Figure 4.
ROC curve associated with prediction of risk factors of patients with ischemic stroke that were included or excluded from rtPA in obese patients with AIS. Higher AUC values in ROC analysis indicate better discrimination of the score for the measured outcome. Classification table (overall correctly classified percentage  =  62.4%) and area under the ROC curve (AUROC  =  0.729 [95% CI 0.704-0.755]) applied to check model fitness.
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