Acute Ischemic Stroke and COVID-19: An Analysis of 27 676 Patients

Overview

Journal Stroke

Specialties Cardiology & Vascular Diseases
Neurology

Date 2021 Feb 4

PMID 33535779

Citations 150

Authors

Adnan I Qureshi

William I Baskett

Wei Huang

Daniel Shyu

Danny Myers

Murugesan Raju

Iryna Lobanova

M Fareed K Suri

S Hasan Naqvi

Brandi R French

Farhan Siddiq

Camilo R Gomez

Chi-Ren Shyu

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Acute ischemic stroke may occur in patients with coronavirus disease 2019 (COVID-19), but risk factors, in-hospital events, and outcomes are not well studied in large cohorts. We identified risk factors, comorbidities, and outcomes in patients with COVID-19 with or without acute ischemic stroke and compared with patients without COVID-19 and acute ischemic stroke.

Methods: We analyzed the data from 54 health care facilities using the Cerner deidentified COVID-19 dataset. The dataset included patients with an emergency department or inpatient encounter with discharge diagnoses codes that could be associated to suspicion of or exposure to COVID-19 or confirmed COVID-19.

Results: A total of 103 (1.3%) patients developed acute ischemic stroke among 8163 patients with COVID-19. Among all patients with COVID-19, the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fibrillation, and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk, 2.1 [95% CI, 1.6-2.4]; <0.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19 513 patients without COVID-19. Among all ischemic stroke patients, COVID-19 was associated with discharge to destination other than home or death (relative risk, 1.2 [95% CI, 1.0-1.3]; =0.03) after adjusting for potential confounders.

Conclusions: Acute ischemic stroke was infrequent in patients with COVID-19 and usually occurs in the presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased 2-fold with occurrence of acute ischemic stroke in patients with COVID-19.

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References

Morassi M, Bagatto D, Cobelli M, Dagostini S, Gigli G, Bna C . Stroke in patients with SARS-CoV-2 infection: case series. J Neurol. 2020; 267(8):2185-2192. PMC: 7238403. DOI: 10.1007/s00415-020-09885-2. View

Laird-Maddox M, Mitchell S, Hoffman M . Integrating research data capture into the electronic health record workflow: real-world experience to advance innovation. Perspect Health Inf Manag. 2015; 11:1e. PMC: 4272439. View

Merkler A, Parikh N, Mir S, Gupta A, Kamel H, Lin E . Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza. JAMA Neurol. 2020; . PMC: 7333175. DOI: 10.1001/jamaneurol.2020.2730. View

Yaghi S, Ishida K, Torres J, Mac Grory B, Raz E, Humbert K . SARS-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020; 51(7):2002-2011. PMC: 7258764. DOI: 10.1161/STROKEAHA.120.030335. View

Qureshi A, Chaudhry S, Sapkota B, Rodriguez G, Suri M . Discharge destination as a surrogate for Modified Rankin Scale defined outcomes at 3- and 12-months poststroke among stroke survivors. Arch Phys Med Rehabil. 2012; 93(8):1408-1413.e1. PMC: 5696633. DOI: 10.1016/j.apmr.2012.02.032. View

Alhajji M, Kawsara A, Alkhouli M . Validation of Acute Ischemic Stroke Codes Using the International Classification of Diseases Tenth Revision. Am J Cardiol. 2020; 125(7):1135. DOI: 10.1016/j.amjcard.2020.01.004. View

Kerleroux B, Fabacher T, Bricout N, Moise M, Testud B, Vingadassalom S . Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays. Stroke. 2020; 51(7):2012-2017. DOI: 10.1161/STROKEAHA.120.030373. View

Qureshi A, Abd-Allah F, Al-Senani F, Aytac E, Borhani-Haghighi A, Ciccone A . Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel. Int J Stroke. 2020; 15(5):540-554. DOI: 10.1177/1747493020923234. View

Warren-Gash C, Blackburn R, Whitaker H, McMenamin J, Hayward A . Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. Eur Respir J. 2018; 51(3). PMC: 5898931. DOI: 10.1183/13993003.01794-2017. View

10.

Klok F, Kruip M, van der Meer N, Arbous M, Gommers D, Kant K . Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020; 191:148-150. PMC: 7192101. DOI: 10.1016/j.thromres.2020.04.041. View

11.

Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y . Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020; 5(3):279-284. PMC: 7371480. DOI: 10.1136/svn-2020-000431. View

12.

Teo K, Leung W, Wong Y, Liu R, Chan A, Choi O . Delays in Stroke Onset to Hospital Arrival Time During COVID-19. Stroke. 2020; 51(7):2228-2231. PMC: 7258759. DOI: 10.1161/STROKEAHA.120.030105. View

13.

Smeeth L, Thomas S, Hall A, Hubbard R, Farrington P, Vallance P . Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004; 351(25):2611-8. DOI: 10.1056/NEJMoa041747. View

14.

Escalard S, Maier B, Redjem H, Delvoye F, Hebert S, Smajda S . Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19: Experience From Paris. Stroke. 2020; 51(8):2540-2543. PMC: 7282400. DOI: 10.1161/STROKEAHA.120.030574. View

15.

Benussi A, Pilotto A, Premi E, Libri I, Giunta M, Agosti C . Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy. Neurology. 2020; 95(7):e910-e920. DOI: 10.1212/WNL.0000000000009848. View

16.

Qin C, Zhou L, Hu Z, Yang S, Zhang S, Chen M . Clinical Characteristics and Outcomes of COVID-19 Patients With a History of Stroke in Wuhan, China. Stroke. 2020; 51(7):2219-2223. PMC: 7282412. DOI: 10.1161/STROKEAHA.120.030365. View

17.

Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X . High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020; 46(6):1089-1098. PMC: 7197634. DOI: 10.1007/s00134-020-06062-x. View

18.

Chan J, Yip C, To K, Tang T, Wong S, Leung K . Improved Molecular Diagnosis of COVID-19 by the Novel, Highly Sensitive and Specific COVID-19-RdRp/Hel Real-Time Reverse Transcription-PCR Assay Validated and with Clinical Specimens. J Clin Microbiol. 2020; 58(5). PMC: 7180250. DOI: 10.1128/JCM.00310-20. View

19.

Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T . Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020; 191:9-14. PMC: 7177070. DOI: 10.1016/j.thromres.2020.04.024. View

20.

Hassan A, Chaudhry S, Grigoryan M, Tekle W, Qureshi A . National trends in utilization and outcomes of endovascular treatment of acute ischemic stroke patients in the mechanical thrombectomy era. Stroke. 2012; 43(11):3012-7. PMC: 3523170. DOI: 10.1161/STROKEAHA.112.658781. View