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Observational Study
. 2020 Dec;51(12):3570-3576.
doi: 10.1161/STROKEAHA.120.031217. Epub 2020 Oct 27.

Ischemic Stroke Occurs Less Frequently in Patients With COVID-19: A Multicenter Cross-Sectional Study

Kimon Bekelis  1   2   3   4 , Symeon Missios  3   4 , Javaad Ahmad  3   4 , Nicos Labropoulos  5 , Clemens M Schirmer  6 , Daniel R Calnan  7 , Jonathan Skinner  2   8 , Todd A MacKenzie  2   3   9
Affiliations
Observational Study

Ischemic Stroke Occurs Less Frequently in Patients With COVID-19: A Multicenter Cross-Sectional Study

Kimon Bekelis et al. Stroke. 2020 Dec.

Abstract

Background and purpose: The impact of coronavirus disease 2019 (COVID-19) on the occurrence of ischemic stroke has been the subject of increased speculation but has not been confirmed in large observational studies. We investigated the association between COVID-19 and stroke.

Methods: We performed a cross-sectional study involving patients discharged from a healthcare system in New York State, from January to April 2020. A mixed-effects logistic regression analysis and a propensity score-weighted analysis were used to control for confounders and investigate the association of COVID-19 with ischemic stroke. Similar techniques were used to detect the impact of concurrent COVID-19 infection on unfavorable outcomes for patients with stroke.

Results: Among 24 808 discharges, 2513 (10.1%) were diagnosed with COVID-19, and 566 (0.2%) presented with acute ischemic stroke. Patients diagnosed with COVID-19 were at one-quarter the odds of stroke compared with other patients (odds ratio, 0.25 [95% CI, 0.16-0.40]). This association was consistent in all age groups. Our results were robust in sensitivity analyses, including propensity score-weighted regression models. In patients presenting with stroke, concurrent infection with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was associated with higher case-fatality (odds ratio, 10.50 [95% CI, 3.54-31.18]) and a trend towards increased occurrence of discharge to rehabilitation (odds ratio, 2.45 [95% CI, 0.81-1.25]).

Conclusions: Using a comprehensive cross-section of patients from a large NY-based healthcare system, we did not identify a positive association between ischemic stroke and COVID-19. However, patients with stroke with COVID-19 had worse outcomes compared with those without, with over a 9-fold increase in mortality. 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.

Keywords: COVID-19; coronary artery disease; heart failure; infection; propensity score.

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Conflict of interest statement

Dr Schirmer reports research support (not directly for this article) from Penumbra, is a Shareholder in Neurotechnology Investors, and receives Honorarium from American Association of Neurological Surgeons (not directly related to this article). Dr Skinner reports research support (not directly for this article) from National Institute on Aging, Consulting fee from Sutter Health, Investor in Dorsata, Inc, and is a Program Director at National Bureau of Economic Research, Inc. The other authors report no conflicts.

Figures

Figure.
Figure.
The counts of ischemic stroke, transient ischemic attack (TIA), myocardial infarction (MI), and coronavirus disease 2019 (COVID-19) patients between January and April 2020 are plotted and smoothed using locally estimated scatterplot smoothing. Discharges from the last 10 d of April were excluded from the graph to avoid demonstrating a false drop in cases, given that a significant number of these patients were still inpatients at the time of the study.
See this image and copyright information in PMC

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