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

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Objective

Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus and highlights the potential impact of coronavirus disease (COVID‐19) on the management and outcomes of acute stroke. We conducteda 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 (95%CI).

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 non‐infected 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 non‐infected contemporary or historical controls (OR=1.39, 95%CI:1.04‐1.86; 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 for in‐hospital mortality were higher among SARS‐CoV‐2stroke patients compared to non‐infected 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.

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