Acute Cerebrovascular Events With COVID-19 Infection

Dec 18, 2020
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Authors:
Dhamoon MS, Thaler A, Gururangan K, et al., on behalf of the Mount Sinai Stroke Investigators.
Citation:
Acute Cerebrovascular Events With COVID-19 Infection. Stroke 2020;Dec 7:[Epub ahead of print].
Summary By:
Mollie McDermott, MD, MS

Quick Takes

  • Initial stroke severity is higher among COVID-positive stroke patients than COVID-negative patients.
  • Patients with COVID-19 have worse in-hospital outcomes than COVID-negative patients.
  • Comorbid stroke and COVID-19 are a deadly combination: in this study, in-hospital death was observed in a third of COVID-positive stroke patients.
 

Study Questions:

What are the characteristics and short-term outcomes of patients admitted with acute cerebrovascular disease to a large health system in New York City during March and April of the coronavirus disease 2019 (COVID-19) pandemic?

Methods:

This is a retrospective observational analysis using the Mount Sinai Health System (MSHS) stroke dataset. Consecutive patients admitted with acute cerebrovascular disease were included in the analysis.

Results:

During March and April 2020, 277 patients were admitted to MSHS with acute cerebrovascular disease. Of these, 105 (38%) were COVID-positive. Of the COVID-positive patients, 48 (45.7%) were treated with anticoagulation. No differences between COVID-positive and COVID-negative patients were observed in age, race/ethnicity, prior cerebrovascular disease, hypertension, or atrial fibrillation or flutter. A higher proportion of COVID-negative patients were smokers (47.1% vs. 28.3%, p = 0.014). Stroke severity was higher among COVID-positive patients than COVID-negative patients (mean National Institutes of Health Stroke Score [NIHSS] on presentation 15.5 vs. 9.6; p < 0.0001). More ischemic strokes were classified as cryptogenic for COVID-positive patients compared to COVID-negative patients (51.8% vs. 22.3%). Fifty-four (51.9%) COVID-positive patients experienced neurological worsening during admission compared with 35 (21%) COVID-negative patients (p < 0.0001). In-hospital death occurred in 35 (33%) COVID-positive patients, compared with 22 (12.9%) COVID-negative patients. Only 24 (22.9%) COVID-positive patients were discharged home compared with 84 (49.4%) COVID-negative patients.

Conclusions:

In this observational analysis of 277 consecutive patients admitted with acute cerebrovascular disease to a large health system in New York City during March and April of the COVID-19 pandemic, stroke patients with COVID-19 had more severe strokes and worse short-term outcomes than patients without COVID-19. The higher proportion of cryptogenic stroke among COVID-positive patients should be interpreted with caution because a diagnosis of COVID-19 may have led to a less exhaustive workup for stroke etiology in these patients.

Perspective:

Comorbid stroke and COVID-19 are a deadly combination: In this study, in-hospital death was observed in a third of COVID-positive stroke patients (compared to 5% of all stroke patients over the same months in 2019). Stroke centers should anticipate a sicker stroke patient population during COVID-19 flares and respond with an increase in staffing and resources.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, COVID-19 Hub, Prevention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension, Smoking

Keywords: Anticoagulants, Atrial Fibrillation, Brain Ischemia, Cerebrovascular Disorders, Coronavirus, COVID-19, Ethnic Groups, Hospital Mortality, Hypertension, Intracranial Hemorrhage, Hypertensive, Patient Discharge, Secondary Prevention, severe acute respiratory syndrome coronavirus 2, Smoking, Stroke, Subarachnoid Hemorrhage, Vascular Diseases


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