Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke
Authors: Ntaios George , Michel Patrik , Georgiopoulos Georgios , Guo Yutao , Li Wencheng , Xiong Jing , Calleja Patricia , Ostos Fernando , González-Ortega Guillermo , Fuentes Blanca , Alonso de Leciñana María , Díez-Tejedor Exuperio , García-Madrona Sebastian , Masjuan Jaime , DeFelipe Alicia , Turc Guillaume , Gonçalves Bruno , Domigo Valerie , Dan Gheorghe-Andrei , Vezeteu Roxana , Christensen Hanne , Christensen Louisa Marguerite , Meden Per , Hajdarevic Lejla , Rodriguez-Lopez Angela , Díaz-Otero Fernando , García-Pastor Andrés , Gil-Nuñez Antonio , Maslias Errikos , Strambo Davide , Werring David J. , Chandratheva Arvind , Benjamin Laura , Simister Robert , Perry Richard , Beyrouti Rahma , Jabbour Pascal , Sweid Ahmad , Tjoumakaris Stavropoula , Cuadrado-Godia Elisa , Campello Ana Rodríguez , Roquer Jaume , Moreira Tiago , Mazya Michael V. , Bandini Fabio , Matz Karl , Iversen Helle K. , González-Duarte Alejandra , Tiu Cristina , Ferrari Julia , Vosko Milan R. , Salzer Helmut J.F. , Lamprecht Bernd , Dünser Martin W. , Cereda Carlo W. , Quintero Ángel Basilio Corredor , Korompoki Eleni , Soriano-Navarro Eduardo , Soto-Ramírez Luis Enrique , Castañeda-Méndez Paulo F. , Bay-Sansores Daniela , Arauz Antonio , Cano-Nigenda Vanessa , Kristoffersen Espen Saxhaug , Tiainen Marjaana , Strbian Daniel , Putaala Jukka , Lip Gregory Y.H. 
Published: July 2020

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4–18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4–18] versus 6 [IQR, 3–14]),
P
=0.03; (odds ratio, 1.69 [95% CI, 1.08–2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2–6] versus 2 [IQR, 1–4],
P
<0.001) and death (odds ratio, 4.3 [95% CI, 2.22–8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.