Division of Neurointerventional Radiology, Department of Radiology
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Infectious Disease | Nervous System Diseases | Virus Diseases
Background: Acute ischemic stroke (AIS) in the context of COVID-19 has received considerable attention for its propensity to affect patients of all ages. We aimed to evaluate the effect of age on functional outcome and mortality following an acute ischemic event.
Methods and Results: A prospectively maintained database from comprehensive stroke centers in Canada and the United States was analyzed for patients with AIS from March 14 to September 30, 2020 who tested positive for SARS-CoV-2. The primary outcome was Modified Rankin Scale score at discharge, and the secondary outcome was mortality. Baseline characteristics, laboratory values, imaging, and thrombectomy workflow process times were assessed. Among all 126 patients with COVID-19 who were diagnosed with AIS, the median age was 63 years (range, 27-94). There were 35 (27.8%) patients with AIS in the aged < /=55 years group, 47 (37.3%) in the aged 56 to 70 group, and 44 (34.9%) in the aged > 70 group. Intravenous tissue plasminogen activator and thrombectomy rates were comparable across these groups, (P=0.331 and 0.212, respectively). There was a significantly lower rate of mortality between each group favoring younger age (21.9% versus 45.0% versus 48.8%, P=0.047). After multivariable adjustment for possible confounders, a 1-year increase in age was significantly associated with fewer instances of a favorable outcome of Modified Rankin Scale 0 to 2 (odds ratio [OR], 0.95; 95 CI%, 0.90-0.99; P=0.048) and higher mortality (OR, 1.06; 95 CI%, 1.02-1.10; P=0.007).
Conclusions: AIS in the context of COVID-19 affects young patients at much greater rates than pre-pandemic controls. Nevertheless, instances of poor functional outcome and mortality are closely tied to increasing age.
COVID‐19 pandemic, SARS‐CoV‐2, acute ischemic stroke, age outcomes
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Copyright © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
DOI of Published Version
Dmytriw AA, Dibas M, Schirmer CM, Settecase F, Heran MKS, Efendizade A, Kühn AL, Puri AS, Ospel J, Menon B, Sivakumar S, Mowla A, Vela-Duarte D, Linfante I, Dabus G, Regenhardt RW, Patel AB, Leslie-Mazwi T, D'Amato S, Rosenthal J, Zha A, Talukder N, Sheth S, Cooke D, Leung LY, Malek A, Voetsch B, Sehgal S, Wakhloo AK, Wu H, Cohen J, Turkel-Parella D, Xavier A, Tiwari A; North American Neurovascular COVID‐19 (NAN‐C) Consortium. Age and Acute Ischemic Stroke Outcome in North American Patients With COVID-19. J Am Heart Assoc. 2021 Jul 3:e021046. doi: 10.1161/JAHA.121.021046. Epub ahead of print. PMID: 34219466. Link to article on publisher's site
Journal of the American Heart Association
Dmytriw AA, Kuhn AL, Puri AS. (2021). Age and Acute Ischemic Stroke Outcome in North American Patients With COVID-19. COVID-19 Publications by UMass Chan Authors. https://doi.org/10.1161/JAHA.121.021046. Retrieved from https://escholarship.umassmed.edu/covid19/262
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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.