Acute Ischemic Stroke in COVID-19 Patients: GWTG-Stroke Analysis

Quick Takes

  • Acute ischemic stroke patients with COVID-19 have more severe strokes and worse outcomes compared to patients without COVID-19.
  • Acute ischemic stroke patients with COVID-19 have longer door-to-treatment times than stroke patients without COVID-19.
  • A disproportionate burden of comorbid stroke and COVID-19 falls upon non-White populations.

Study Questions:

What are the characteristics, diagnostics, and outcomes of patients with acute ischemic stroke and coronavirus disease 2019 (COVID-19) in the United States?

Methods:

This is an analysis of the large Get With the Guidelines–Stroke (GWTG-Stroke) registry that includes data from over 2,000 participating US hospitals. Patient-level data are collected retrospectively. This study’s population consisted of 41,971 patients with acute ischemic stroke hospitalized between February 4 and June 29, 2020 at one of 458 GWTG-Stroke hospitals that had ≥1 COVID-19 case. Of the 41,971 patients, 1,143 (2.7%) had a diagnosis of COVID-19. Because of the structure of the registry, the investigators were unable to control for COVID-19 severity or treatments.

Results:

Compared to acute ischemic stroke patients without COVID-19, patients with COVID-19:

  • Were younger (median age 68 years vs. 71 years, p < 0.001)
  • Were more likely to be Asian, non-Hispanic Black, or Hispanic (51.8% vs. 32.7%, p < 0.001)
  • Were more likely to have Medicaid or self-pay/no insurance (25.3% vs. 17%, p < 0.001)
  • Had higher median National Institutes of Health Stroke Scale [range 0-42] scores (8 vs. 4, p < 0.001)
  • Were more likely to have large vessel occlusion (30.4% vs. 23.6%, p < 0.001)
  • Had longer median door-to-needle times (58.5 min vs. 46 min, p < 0.001)
  • Had longer median door-to-endovascular therapy times (114 min vs. 90 min, p = 0.002)
  • Were more likely to die in the hospital (adjusted odds ratio [aOR], 4.34; 95% confidence interval [CI], 3.48-5.40)
  • Were less likely to be discharged with a favorable disability score (aOR, 0.65; 95% CI, 0.52-0.81)

Conclusions:

In this large US registry, acute ischemic stroke patients with COVID-19 were more likely to be Asian, Non-Hispanic Black, and Hispanic; were more likely to have Medicaid or no insurance; had more severe strokes; had longer door-to-treatment times; and had worse outcomes compared to acute ischemic stroke patients without COVID-19.

Perspective:

These data corroborate the results of prior studies suggesting that acute ischemic stroke patients with COVID-19 have more severe strokes and worse outcomes than stroke patients without COVID-19. The longer door-to-treatment times observed in COVID-19 patients likely reflect the need for modified acute stroke protocols related to donning personal protective equipment and ensuring appropriate infection control. A disproportionate burden of comorbid stroke and COVID-19 falls upon non-White populations and people with Medicaid or no insurance.

Clinical Topics: Prevention

Keywords: Brain Ischemia, Coronavirus, COVID-19, Endovascular Procedures, Ethnic Groups, Insurance Coverage, Patient Discharge, Secondary Prevention, Stroke, Time-to-Treatment, Vascular Diseases


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