Stroke and COVID-19: A Multicenter Cross-Sectional Study

There is no positive association between ischemic stroke and coronavirus disease 2019 (COVID-19). However, patients with stroke and COVID-19 had worse outcomes and higher mortality compared to patients without, according to a multicenter, cross-sectional study published in Stroke.

There has been recent speculation that COVID-19 is associated with increased risk of fatal ischemic stroke in young adults, propagated by a procoagulable state in infected patients. However, other reports have indicated decreased occurrences of ischemic stroke due to the COVID-19 pandemic. To investigate the association of COVID-19 and ischemic stroke, investigators used discharge data from 6 hospitals in New York, all of which are Comprehensive Centers and 5 were Advanced Primary Stroke Centers. Between January and April, a total of 24,808 patients were included in the analysis. In order to control for confounders and to detect the impact of concurrent COVID-19 infection on unfavorable outcomes for patients with stroke, a mixed-effects logistic regression analysis and a propensity score-weighted analysis were used.

Of 2513 patients (10.1%) who were identified and diagnosed with COVID-19, 55.8% were men and the average age was 72.7 years. There were 566 patients with COVID-19 who presented with acute ischemic stroke; 53.5% were female with an average age of 72.7 years.

Results suggest no positive association between ischemic stroke and COVID-19. The odds of ischemic stroke in patients with COVID-19 was 0.35 times lower (95% CI, 0.23-0.55) than patients without COVID-19. After controlling for patient characteristics and comorbidities, investigators used a logistic regression with facility fixed effects, and calculated that the odds of stroke was 0.25 times lower (95% CI, 0.16-0.40; P <.001) in patients with COVID-19 compared to patients without COVID-19. Additionally, this lack of association persisted when ischemic stroke (OR 0.29; 95% CI 0.18-0.48; P <.001) and transient ischemic attacks (OR 0.14; 95% CI 0.10-0.38; P <.001) were analyzed separately.

In patients who presented with acute ischemic stroke, a concurrent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was associated with a 9-fold increase in mortality compared to patients without concurrent SARS-CoV-2 (31.8% vs 4.6%; OR, 10.50; 95% CI, 3.54-31.18; P <.001).

A limitation of this study is the lack of post-hospitalization and long-term data on the patients analyzed. Additionally, strokes were not divided into subtypes, therefore, there is a possibility that one cause of stroke may occur more frequently in patients diagnosed with COVID-19.

Investigators “did not observe a positive association of COVID-19 and ischemic stroke,” potentially due patients’ fear of exposure to SARS-CoV-2 in emergency rooms. “Although no definitive conclusions can be reached from our observational study, our data do not support the concerns for an epidemic of stroke in young adults with COVID-19,” study authors concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Bekelis K, Missios S, Ahmad J, et al. Ischemic stroke occurs less frequently in patients with COVID-19: a multicenter cross-sectional study. Stroke. Published online October 27, 2020. doi:10.1161/STROKEAHA.120.031217.