TY - JOUR
TI - The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-Analysis
AU - Katsanos, A.H.
AU - Palaiodimou, L.
AU - Zand, R.
AU - Yaghi, S.
AU - Kamel, H.
AU - Navi, B.B.
AU - Turc, G.
AU - Romoli, M.
AU - Sharma, V.K.
AU - Mavridis, D.
AU - Shahjouei, S.
AU - Catanese, L.
AU - Shoamanesh, A.
AU - Vadikolias, K.
AU - Tsioufis, K.
AU - Lagiou, P.
AU - Alexandrov, A.V.
AU - Tsiodras, S.
AU - Tsivgoulis, G.
JO - Annals of Neurology
PY - 2021
VL - 89
TODO - 2
SP - 380-388
PB - John Wiley and Sons Inc
SN - 0364-5134, 1531-8249
TODO - 10.1002/ana.25967
TODO - fibrinolytic agent, adult;  adverse outcome;  Article;  brain hemorrhage;  brain ischemia;  cerebral sinus thrombosis;  cerebrovascular accident;  cerebrovascular disease;  clinical evaluation;  cohort analysis;  comparative study;  controlled study;  coronavirus disease 2019;  demography;  diabetes mellitus;  disease association;  fibrinolytic therapy;  historical research;  hospital mortality;  hospital patient;  human;  observational study;  pandemic;  patient care;  percutaneous thrombectomy;  prevalence;  priority journal;  prospective study;  retrospective study;  Severe acute respiratory syndrome coronavirus 2;  stroke patient;  systematic review;  case control study;  cerebrovascular accident;  comorbidity;  hospital mortality;  meta analysis;  thrombectomy, Case-Control Studies;  Comorbidity;  COVID-19;  Diabetes Mellitus;  Hospital Mortality;  Humans;  SARS-CoV-2;  Stroke;  Thrombectomy;  Thrombolytic Therapy
TODO - 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%, 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 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, 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 noninfected historical controls (OR = 1.39, 95% CI = 1.00–1.94, 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 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, 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. ANN NEUROL 2021;89:380–388. © 2020 American Neurological Association
ER -