The Impact of SARS‐CoV‐2 on Stroke Epidemiology and Care: A Meta‐Analysis

• Published in: Annals of neurology Vol. 89; no. 2; pp. 380 - 388
• Main Authors: Katsanos, Aristeidis H., Palaiodimou, Lina, Zand, Ramin, Yaghi, Shadi, Kamel, Hooman, Navi, Babak B., Turc, Guillaume, Romoli, Michele, Sharma, Vijay K., Mavridis, Dimitris, Shahjouei, Shima, Catanese, Luciana, Shoamanesh, Ashkan, Vadikolias, Konstantinos, Tsioufis, Konstantinos, Lagiou, Pagona, Alexandrov, Andrei V., Tsiodras, Sotirios, Tsivgoulis, Georgios
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.02.2021; Wiley Subscription Services, Inc; Wiley
• Subjects: Cardiovascular system; Case-Control Studies; Comorbidity; Confidence intervals; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - epidemiology; Diabetes mellitus; Diabetes Mellitus - epidemiology; Epidemiology; Health risks; Hemorrhage; Hospital Mortality; Humans; Infections; Intravenous administration; Ischemia; Life Sciences; Meta-analysis; Mortality; Mortality risk; Neurons and Cognition; Pandemics; Respiratory diseases; Risk; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Stroke; Stroke - epidemiology; Thrombectomy - statistics & numerical data; Thrombolysis; Thrombolytic drugs; Thrombolytic Therapy - statistics & numerical data; Viral diseases
• ISSN: 0364-5134; 1531-8249; 1531-8249
• DOI: 10.1002/ana.25967

Objective Emerging data indicate an increased risk of cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and highlight the potential impact of coronavirus disease (COVID‐19) on the management and outcomes of acute stroke. We conducted a systematic review and meta‐analysis to evaluate the aforementioned considerations. Methods We performed a meta‐analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARS‐CoV‐2 infection status. We used a random‐effects model. Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Results We identified 18 cohort studies including 67,845 patients. Among patients with SARS‐CoV‐2, 1.3% (95% CI = 0.9–1.6%, I2 = 87%) were hospitalized for cerebrovascular events, 1.1% (95% CI = 0.8–1.3%, I2 = 85%) for ischemic stroke, and 0.2% (95% CI = 0.1–0.3%, I2 = 64%) for hemorrhagic stroke. Compared to noninfected contemporary or historical controls, patients with SARS‐CoV‐2 infection had increased odds of ischemic stroke (OR = 3.58, 95% CI = 1.43–8.92, I2 = 43%) and cryptogenic stroke (OR = 3.98, 95% CI = 1.62–9.77, I2 = 0%). Diabetes mellitus was found to be more prevalent among SARS‐CoV‐2 stroke patients compared to noninfected historical controls (OR = 1.39, 95% CI = 1.00–1.94, I2 = 0%). SARS‐CoV‐2 infection status was not associated with the likelihood of receiving intravenous thrombolysis (OR = 1.42, 95% CI = 0.65–3.10, I2 = 0%) or endovascular thrombectomy (OR = 0.78, 95% CI = 0.35–1.74, I2 = 0%) among hospitalized ischemic stroke patients during the COVID‐19 pandemic. Odds of in‐hospital mortality were higher among SARS‐CoV‐2 stroke patients compared to noninfected contemporary or historical stroke patients (OR = 5.60, 95% CI = 3.19–9.80, I2 = 45%). Interpretation SARS‐CoV‐2 appears to be associated with an increased risk of ischemic stroke, and potentially cryptogenic stroke in particular. It may also be related to an increased mortality risk. ANN NEUROL 2021;89:380–388