Early reports identified an association between coronavirus disease 2019 (COVID-19) and the cerebrovascular system. Researchers sought to identify and characterize stroke in COVID-19 by comparing a diverse patient population from the New York metropolitan area with historical ischemic stroke cases unaffected by COVID-19. A low rate of imaging-confirmed ischemic stroke was found in patients hospitalized with COVID-19 in this geographic area. Patients with COVID-19 and stroke were found to have a higher mortality than historical and contemporary controls, according to research published in Stroke.
Three comprehensive stroke centers in the New York metropolitan area (NYU Langone Manhattan, NYU Langone Brooklyn in Sunset Park, and NYU Langone Winthrop in Mineola, Long Island) provided data of acute ischemic stroke patients admitted March 15, 2020, to April 19, 2020. A historical control was included of patients from 2 facilities (NYU Langone Manhattan and NYU Langone Brooklyn) with a discharge diagnosis of ischemic stroke between March 15, 2019 and April 15, 2019.
A general diagnostic evaluation was recorded. There were no sample-size calculations performed and patients were divided into three groups: group 1 included patients affected by both ischemic stroke and COVID-19, group 2 consisted of patients with ischemic stroke but not with COVID-19, and group 3 included patients with ischemic stroke without COVID-19 over the same time frame.
Thirty two (0.9%) of the 3,556 patients who were hospitalized for COVID-19 were noted to have ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to both contemporary controls (30.4%, P =.003) and historical controls (25.0%, P < .001).
Patients with COVID-19 had higher National Institutes of Health Stroke Scale scores upon admission and higher peak D-dimer levels compared with contemporary controls. Patients with COVID-19 were more likely to be younger men with elevated troponin levels, higher admission National Institutes of Health Stroke Scale scores, and higher erythrocyte sedimentation rates compared with historical controls.
Patients receiving a diagnosis of both COVID-19 and stroke had significantly higher mortality than both historical and contemporary controls.
The researchers discussed that the rate of ischemic stroke in infected patients in their New York City hospital system was lower compared with results reported from China. Possible reasons for the difference might be related to race variations and that the low rate of ischemic stroke may be underestimated due to a difficulty in identifying stroke in patients who are critically ill and sedated.
The researchers stated that the initial spike of reported ischemic stroke has greatly decreased, a finding most likely related to social distancing practices and stay at home policies. Another variable was therapeutic anticoagulation initiated in patients with high D-dimer levels.
“In patients with COVID-19 and ischemic stroke, a majority of strokes were classified as cryptogenic, possibly related to an acquired hypercoagulability, and were associated with increased mortality,” the study authors noted. “Ongoing studies are testing the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention.”
Shadi Y, Koto I, Jose T, et al. SARS2-CoV-2 and stroke in a New York healthcare system [published online ahead of print May 20, 2020]. Stroke. doi:10.1161/STROKEAHA.120.030335