Outcomes of Ischemic Stroke in Young Adults With COVID-19

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Young adults with COVID-19 have been found to have a low incidence but poor prognosis of acute ischemic stroke.

While the incidence of acute ischemic stroke in young adults (aged ≤ 50 years) with coronavirus disease 2019 (COVID-19) is low, the prognosis of stroke in these patients is poor, according to study results published in The American Journal of Cardiology.

While limited data are available on ischemic stroke in patients with COVID-19, a recent study reported that young adults with the viral infection may be at risk for large ones. The goal of the current focused analysis was to explore the incidence and outcomes of acute ischemic stroke in young adults with COVID-19.

The researchers identified young adults with laboratory confirmed diagnosis of COVID-19 from January 20 to April 24, 2020. Using the TriNetx Research Network, a global federated health research network of 37 global healthcare organizations worldwide, they completed patient selection. 

The study cohort included 9358 patients with COVID-19, of whom approximately one third (33.2%) were hospitalized for severe symptoms. The researchers identified 64 subjects (0.7%) with a diagnosis of acute ischemic stroke.

Compared to those who did not develop stroke, patients with acute ischemic stroke were older (mean age 39.3±9.0 vs 36.7±8.5 y, respectively; P <.001), with an increased incidence of comorbidities. These included hypertension (61.0% vs 11.7%), diabetes (32.8% vs 6.5%), heart failure (15.6% vs 1.5%), chronic obstructive lung disease (15.6% vs 1.0%), prior history of stroke (28.1% vs 0.5%), and renal insufficiency (15.6% vs 2.0%) (P < .001 for all).

Furthermore, nicotine dependence (34.4% vs 5.9%; P <.001) and obesity (46.9% vs 17.4%; P <.001) were more common in the group of patients with acute ischemic stroke.

Survival rates were lower in the group of patients with acute ischemic stroke when compared to those without stroke, with all-cause mortality of 15.6% (10 of 64 patients with acute ischemic stroke) vs 0.6% (58 of 9294 patients without stroke) (P < .001).

The study had several limitations, including the observational design and lack of a control group without COVID-19.

“We found a low overall incidence but a grim prognosis of acute ischemic stroke among unselected young adults with COVID-19,” concluded the researchers.


Annie F, Bates MC, Nanjundappa A, Bhatt DL, Alkhouli M. Prevalence and outcomes of acute ischemic stroke among patients ≤ 50 years of age with laboratory confirmed COVID-19 infection (published online June 9, 2020). Am J Cardiol. doi:10.1016/j.amjcard.2020.06.010.