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COVID-19 and Incidence of Ischemic Stroke and Acute MI
Quick Takes
- The relationship between active COVID-19 infection and ischemic cardiovascular events remains unclear.
- In this registry-based study of Danish patients with a positive test for COVID-19, patients were much more likely to be diagnosed with ischemic stroke or AMI in the 14 days following their COVID-19 diagnosis than at other times.
- While these results are interesting, they do not answer the important question about whether there is something unique about COVID-19 infection (as opposed to any other acute medical illness) that confers an increased risk of ischemic stroke and AMI.
Study Questions:
Does active coronavirus disease 2019 (COVID-19) infection confer an increased risk of ischemic stroke and acute myocardial infarction (AMI)?
Methods:
This is a registry-based study of all patients with a positive test for COVID-19 admitted to Danish hospitals up to July 16, 2020. Using International Classification of Diseases, Tenth Revision codes, the investigators identified all patients who were admitted with either a primary or secondary diagnosis of first-ever ischemic stroke or first-ever AMI up to 180 days prior to COVID-19 diagnosis and until July 16, 2020. The interval of interest was the 14 days following the date of laboratory-confirmed COVID-19 diagnosis. The control interval was the 180 days prior to the COVID-19 diagnosis and until the end of available data collection, excluding the 14-day risk interval. Each subject was used as his or her own control. Incidence ratios were reported.
Results:
A total of 5,119 patients diagnosed with COVID-19 were included in the analysis. Forty-four patients (0.86%) received a diagnosis of ischemic stroke, and 18 (41%) received this diagnosis during the 14-day risk interval. The incidence ratio of ischemic stroke during the risk period compared to the control period was 12.9 (95% confidence interval [CI], 7.1-23.5). Seventeen patients (0.33%) received a diagnosis of AMI, and four (23.5%) received this diagnosis during the 14-day risk interval. The incidence ratio of AMI during the risk period compared to the control period was 5.9 (95% CI, 1.9-18.2).
Conclusions:
In this registry-based trial, COVID-19 patients had a higher risk of being diagnosed with ischemic stroke or AMI in the 14 days following their laboratory-confirmed COVID-19 diagnosis (risk interval) than they did during the control interval.
Perspective:
These results may be affected by detection bias since patients with active COVID-19 infection (i.e., patients in the risk period) would presumably have greater contact with the medical system than they would during the control period. Greater contact with the medical system alone can lead to increased diagnoses of ischemic stroke and AMI. It is well known that patients with an active medical illness have a higher risk of ischemic stroke and AMI than those without. It would be interesting to know how many strokes and AMIs in this study occurred in patients with mild or asymptomatic COVID-19, which would suggest that there may be something unique about COVID-19 that confers an increased risk of ischemic stroke or AMI.
Clinical Topics: Acute Coronary Syndromes, COVID-19 Hub, Prevention
Keywords: Acute Coronary Syndrome, Brain Ischemia, Coronavirus, COVID-19, Myocardial Infarction, Risk, Secondary Prevention, severe acute respiratory syndrome coronavirus 2, Stroke, Vascular Diseases
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