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

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

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%, I (2) = 87%) were hospitalized for cerebrovascular events, 1.1% (95% CI = 0.8–1.3%, I (2) = 85%) for ischemic stroke, and 0.2% (95% CI = 0.1–0.3%, I (2) = 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, I (2) = 43%) and cryptogenic stroke (OR = 3.98, 95% CI = 1.62–9.77, I (2) = 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, I (2) = 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, I (2) = 0%) or endovascular thrombectomy (OR = 0.78, 95% CI = 0.35–1.74, I (2) = 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, I (2) = 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 2020