Risk of ischemic stroke in patients hospitalized with COVID-19 in the USA

ISC 2021 Using data of the AHA COVID-19 CVD Registry, risk of ischemic stroke was 0.75% in patients hospitalized with COVID-19, which is lower than previously reported.

Presented at the International Stroke Conference 2021 by Saate Shakil (Seattle, WA, USA)

Introduction and methods

It was noted during the start of the pandemic in 2020 that many young patients were presenting with large vessel stroke as a presenting feature of COVID-19. Studies showed inconsistent risk of stroke among patients with COVID-19 ranging from 0.9 to 2.0%. This raised the question what the risk of ischemic stroke is among patients hospitalized with COVID-19 in the United States. The sample size of the study using the AHA COVID-19 CVD registry was 21,000 compared to 8,000 in previous studies. Furthermore, this study investigated whether there were racial disparities in ischemic stroke among hospitalized patients with COVID-19.

The AHA COVID-19 CVD registry includes 31,659 hospitalized patients with SARS-CoV-2 infection at 160 hospitals from March 2020 – January 2021. Enrollment is still ongoing throughout the pandemic. This study included 21,073 hospitalized COVID-19 patients from March-November 2020

Main results

• 160 Patients experienced an ischemic stroke, translating to an ischemic stroke risk of 0.75% in COVID-19 patients.
• COVID-19 patients who experienced an ischemic stroke were more likely to be older, male and have more risk factors (hypertension, AF, diabetes, cerebrovascular disease, prior stroke) compared to those without stroke.
• Patients with COVID-19 and ischemic stroke were twice as likely to be critically ill, as evidenced by two-fold increase in ICU admission, mechanical ventilation and new renal replacement therapy, compared to those without stroke. Also, two-fold increase in length of hospital stay and in-hospital death was observed in patients with COVID-19 and ischemic stroke compared to COVID-19 patients without stroke.
• Non-Hispanic black patients had higher risk of stroke (0.91%) than Hispanic (0.52%) and non-Hispanic white patients (0.75%).

Conclusion

Risk of ischemic stroke in this cohort of the AHA COVID-19 CVD registry was 0.75%, which is lower than reported in previous studies. COVID-19 patients who experienced an ischemic stroke were more likely to be older, male and have more risk factor compared to COVID-19 patients without a stroke. Outcomes were worse for patients who suffered a stroke compared to those without a stroke. With regard to racial disparities in stroke incidence among hospitalized COVID-19 patients, non-Hispanic black patients had a higher risk than other racial/ethnic groups.

- Our reporting is based on the information provided during ISC 2021 –