Impact of the Pandemic and Concomitant COVID-19 on the Management and Outcomes of Middle Cerebral Artery Strokes: a Nationwide Registry-based Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Feb 28

PMID 38417967

Authors

Abdul Karim Ghaith

Victor Gabriel El-Hajj

Elias Atallah

Jorge Rios Zermeno

Krishnan Ravindran

Maria Gharios

Harry Hoang

Mohamad Bydon

Marcus Ohlsson

Adrian Elmi-Terander

Rabih G Tawk

Pascal Jabbour

Affiliations

Soon will be listed here.

Abstract

Objectives: To investigate the impact of the COVID-19 pandemic as well as concomitant COVID-19 itself on stroke care, focusing on middle cerebral artery (MCA) territory infarctions.

Design: Registry-based study.

Setting: We used the National Inpatient Sample (NIS) database, which covers a wide range of hospitals within the USA.

Participants: The NIS was queried for patients with MCA strokes between 2016 and 2020. In total, 35 231 patients were included.

Outcome Measures: Outcome measures were postprocedural complications, length of stays (LOSs), in-hospital mortality and non-routine discharge. Propensity score matching using all available baseline variables was performed to reduce confounders when comparing patients with and without concomitant COVID-19.

Results: Mechanical thrombectomy (MT) was performed in 48.4%, intravenous thrombolysis (IVT) in 38.2%, and both MT and IVT (MT+IVT) in 13.4% of patients. A gradual increase in the use of MT and an opposite decrease in the use of IVT (p<0.001) was detected during the study period. Overall, 25.0% of all patients were admitted for MCA strokes during the pandemic period (2020), of these 209 (2.4%) were concomitantly diagnosed with COVID-19. Patients with MCA strokes and concomitant COVID-19 were significantly younger (64.9 vs 70.0; p<0.001), had significantly worse NIH Stroke Severity scores, and worse outcomes in terms of LOS (12.3 vs 8.2; p<0.001), in-hospital mortality (26.3% vs 9.8%; p<0.001) and non-routine discharge (84.2% vs 76.9%; p=0.013), as compared with those without COVID-19. After matching, only in-hospital mortality rates remained significantly higher in patients with COVID-19 (26.7% vs 8.5%; p<0.001). Additionally, patients with COVID-19 had higher rates of thromboembolic (12.3% vs 7.6%; p=0.035) and respiratory (11.3% vs 6.6%; p=0.029) complications.

Conclusions: Among patients with MCA stroke, those with concomitant COVID-19 were significantly younger and had higher stroke severity scores. They were more likely to experience thromboembolic and respiratory complications and in-hospital mortality compared with matched controls.

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