COVID Strokes: Rates, Types, Inequalities

Major studies reported at the International Stroke Association of America (ISC) International Stroke Conference came up with more accurate estimates of the stroke effects of COVID-19.

The incidence of ischemic stroke among COVID-19 patients in the American Heart Association (AHA) COVID-19 Table was 0.75% overall, reported Saate Shakil, MD, of the University of Washington in Seattle.

That rate was lower than the 0.9% to 2% reported in other studies of stroke in COVID-19 patients, she noted during a late ISC fracture test session.

However, the range was much larger than those prior studies, which reached about 8,000 patients, she said.

Another factor was that enrollment data expanded from March through November 2020, and the data showed a trend for higher stroke numbers in the spring pandemic peak than in the period thereafter, Shakil said. MedPage today at a press conference.

The study included 21,073 hospitalized patients with SARS-CoV-2 during the study period who had recorded racial or ethnicity information, among the total number of more than 31,000 in the AHA COVID-19 Table CVD as part of the “Get With the Guide” database.

A separate international study of 6,698 COVID-19 patients admitted to nine stroke centers showed a 1.3% incidence of stroke. Of these 88 cases, 60% (53) were major vessel incidents (LVOs).

Although large vessel strokes have been reported in the past, this large series has confirmed it, reported Dileep R. Yavagal, MD, MBBS, of the University of Miami. MedPage today. His group reported the findings at ISC and online in Non-surgery.

The retrospective study included follow-up patients admitted with acute ischemic stroke and COVID-19 from March 1 to May 1, 2020, at 12 stroke centers from four countries, although not three of the centers were excluded from stroke frequency measurement because they only took LVO transfer of patients.

Large vessel occlusion was also more prominent in a separate study of the “Get With The Guidelines-Stroke” database, accounting for 30.4% of acute ischemic strokes in COVID-19 patients versus 23.6% of time. among non-COVID stroke patients.

The study of 41,971 acute ischemic stroke patients (1,143 with COVID-19) was admitted to hospital between February 4 and June 29, 2020, at 458 partner hospitals by Gregg Fonarow, MD, University of California Los Angeles, and colleagues at ISC and online in Stroke.

Findings included the much longer delay in treatment, despite the same levels of thrombolysis and thrombectomy:

• Door to CT: 55 vs. 35 min
• Door to needle: 59 vs 46 min
• Door to endovascular therapy: 114 vs 90 min

Yavagal said this matched his experience. “Looking at our own center data, the COVID-positive patients are delayed due to PPE [personal protective equipment] matters, “he said. In the range of about 10 to 20 minutes it is not, thankfully, very large but it is important in stroke because these neurons are dying. “

Outcomes were also worse for COVID-19 patients, as previously seen in smaller studies. Dispersion with a modified Rankin Scale score of ≤2 was 35% less likely, and in-hospital mortality was more than four times higher compared with other stroke patients.

In Shakil’s study, COVID-19 patients were twice as likely to require ICU care or death, and had twice as long hospital stays than other ischemic stroke patients.

All three studies showed an unbalanced burden of stroke or LVO in COVID-19 among non-Hispanic black patients.

Fonarow’s study also showed an increased risk for Hispanic and Asian patients, but Shakil’s study actually found a lower risk for Hispanic patients. She said it was not clear why that might be, although co-author and AHA President Mitchell Elkind, MD suggested that the timing of the studies may have played a part because it was more severely affected. different areas of the country with different demographics. early versus late in pandemic.

These studies show the strength of large numbers, said ISC chair Louise McCullough, MD, PhD, of the University of Texas Health Science Center at Houston.

She also drew attention to the bigger picture of how diseases in general affect stroke risk.

“We are looking at the immediate impact of COVID,” she said. However, the question for the millions who have passed on it is what is the long-term impact of future events. such data will help answer these questions, she said. “Even if COVID disappears completely next year, it will not. it will never become extinct because of the number of people it has affected and influenced. “

Although it took some effort to update the data forms, Elkind noted that data in AHA records on COVID-19 vaccination will be mined to find out more about the impact on stroke and other clinical issues.