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Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke

George Ntaios 1 Patrik Michel 2 Georgios Georgiopoulos 3 Yutao Guo 4 Wencheng Li 5 Jing Xiong 5 Patricia Calleja 6, 7 Fernando Ostos 6, 7 Guillermo González-Ortega 6, 7 Blanca Fuentes 8, 9 María Alonso de Leciñana 8, 9 Exuperio Díez-Tejedor 8, 9 Sebastian García-Madrona 10, 11 Jaime Masjuan 10, 11 Alicia Defelipe 10, 11 Guillaume Turc 12, 13 Bruno Goncalves 12, 13, 14 Valerie Domigo 12, 13 Gheorghe-Andrei Dan 15, 16 Roxana Vezeteu 15, 16 Hanne Christensen 17 Louisa Marguerite Christensen 17 Per Meden 17 Lejla Hajdarevic 17 Angela Rodriguez-Lopez 18 Fernando Díaz-Otero 18 Andrés García-Pastor 18 Antonio Gil-Nuñez 18 Errikos Maslias 2 Davide Strambo 2 David Werring 19 Arvind Chandratheva 19 Laura Benjamin 19 Robert Simister 19 Richard Perry 19 Rahma Beyrouti 19 Pascal Jabbour 20 Ahmad Sweid 20 Stavropoula Tjoumakaris 20 Elisa Cuadrado-Godia 21, 22, 23 Ana Rodríguez Campello 21, 22, 23 Jaume Roquer 21, 22, 23 Tiago Moreira 24 Michael Mazya 24 Fabio Bandini 25 Karl Matz 26 Helle Iversen 27 Alejandra González-Duarte 28 Cristina Tiu 16, 29 Julia Ferrari 30 Milan Vosko 30 Helmut J.F. Salzer 30 Bernd Lamprecht 30 Martin Dünser 31 Carlo Cereda 32 Ángel Basilio Corredor Quintero 33 Eleni Korompoki 34 Eduardo Soriano-Navarro 35 Luis Enrique Soto-Ramírez 35 Paulo Castañeda-Méndez 35 Daniela Bay-Sansores 35 Antonio Arauz 36 Vanessa Cano-Nigenda 36 Espen Saxhaug Kristoffersen 37, 38 Marjaana Tiainen 39 Daniel Strbian 39 Jukka Putaala 39 Gregory Y.H. Lip 40, 41, 42
Abstract : Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4-18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4-18] versus 6 [IQR, 3-14]), P=0.03; (odds ratio, 1.69 [95% CI, 1.08-2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2-6] versus 2 [IQR, 1-4], P<0.001) and death (odds ratio, 4.3 [95% CI, 2.22-8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.
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Submitted on : Monday, October 19, 2020 - 2:21:33 PM
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George Ntaios, Patrik Michel, Georgios Georgiopoulos, Yutao Guo, Wencheng Li, et al.. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke. Stroke, American Heart Association, 2020, 51 (9), pp.e254-e258. ⟨10.1161/STROKEAHA.120.031208⟩. ⟨inserm-02971375⟩

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