Acute Ischemic Stroke in Patients With COVID-19

Abstract

Background and Purpose: Studies suggest an increased risk of adverse outcomes among patients with acute ischemic stroke (AIS) and coronavirus disease 2019 (COVID-19). Methods: Using Get With The Guidelines–Stroke, we identified 41 971 patients (AIS/COVID-19: 1143; AIS/no COVID-19: 40 828) with AIS hospitalized between February 4, 2020 and June 29, 2020, from 458 Get With The Guidelines–Stroke hospitals with at least one COVID-19 case and evaluated clinical characteristics, treatment patterns, and outcomes. Results: Compared with patients with AIS/no COVID-19, those with AIS/COVID-19 were younger, more likely to be non-Hispanic Black, Hispanic, or Asian, more likely to present with higher National Institutes of Health Stroke Scale scores, and had greater proportions of large vessel occlusions. Rates of thrombolysis and thrombectomy were similar between the groups. Door to computed tomography (median 55 [18–207] versus 35 [14–99] minutes, P <0.001), door to needle (59 [40–82] versus 46 [33–64] minutes, P <0.001), and door to endovascular therapy (114 [74–169] versus 90 [54–133] minutes, P =0.002) times were longer in the AIS/COVID-19 cohort. In adjusted models, patients with AIS/COVID-19 had decreased odds of discharge with modified Rankin Scale score of ≤2 (odds ratio, 0.65 [95% CI, 0.52–0.81], P <0.001) and increased odds of in-hospital mortality (odds ratio, 4.34 [95% CI, 3.48–5.40], P <0.001). ConclusionS: This analysis demonstrates younger age, greater stroke severity, longer times to evaluation and treatment, and worse morbidity and mortality in patients with AIS/COVID-19 compared with those with AIS/no COVID-19.

Acute ischaemic stroke associated with SARS-CoV-2 infection in North America

“…This relationship seems to ring true when we use historical controls of either all-cause ischaemic stroke (non-COVID) or LVOs. We found that mortality was significantly higher than the Get With the Guidelines (GWTG) non-COVID ischaemic cohort (39.1% vs 27.6%) or when compared with the respective LVO study arms in MR CLEAN (37.8% vs 11.6%) 10 12. The North American cohort of our consortium (n=216) fared worse than the comparable global cohort (n=174) of Ntaios et al 11 in terms of both morbidity and mortality.…”

“…We found that mortality was significantly higher than the Get With the Guidelines (GWTG) non-COVID ischaemic cohort (39.1% vs 27.6%) or when compared with the respective LVO study arms in MR CLEAN (37.8% vs 11.6%). 10 12 The North American cohort of our consortium (n=216) fared worse than the comparable global cohort (n=174) of Ntaios et al 11 in terms of both morbidity and mortality. Conversely, we also observed lower rates of favourable outcomes (mRS 0–2) compared with the GWTG non-COVID ischaemic cohort (17.8% vs 39.5%).…”

“…Conversely, we also observed lower rates of favourable outcomes (mRS 0–2) compared with the GWTG non-COVID ischaemic cohort (17.8% vs 39.5%). 10 …”

“…These populations were specifically selected to minimise classification bias and compare study cohorts with the least possible overlap. For our non-COVID comparison we included the non-COVID all-cause ischaemic stroke cohort from the recently published ‘GWTG-Stroke Acute Ischemic Stroke & COVID-19 Registry.’10 This population was chosen for its contemporary and observational aspects to best represent an appropriate control for our North American study population. For our COVID-19 comparison, we selected the Global COVID-19 Stroke Registry11 as some of our centres were previously included in contemporaneous North American registries therefore could not serve as an effective control due to overlap 11.…”

Documento de posición COVID-19 y corazón

“…En un registro de ACV en Estados Unidos que incluyó a 1143 pacientes con COVID-19 y ACV concomitante, la mediana de edad fue de 65,3 años (RIC 61,4-67,6) años, una diferencia mediana de −6,0 años (IC 95% −12,3 a −1,4) con aquellos pacientes que cursaron un ACV pero sin COVID-19 en el mismo período. (52,(60)(61)(62) Se observó que los pacientes con ACV y COVID-19 presentaban menor frecuencia de hipertensión arterial previa, sin diferencias significativas en los otros factores de riesgo cardiovasculares. Se evidenció mayor presencia de oclusión de grandes vasos y mayor gravedad clínica manifestada por un score del National Institute of Health Stroke Scale (NIHSS) más elevado que en aquellos que no presentaron paralelamente infección por COVID-19.…”