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Abstract
Background Preliminary studies show that patients with large vessel occlusion (LVO) acute ischemic strokes have worse outcomes with concurrent COVID-19 infection. We investigated the outcomes for patients with LVO strokes undergoing mechanical thrombectomy (MT) with concurrent COVID-19 infection.
Methods The National Inpatient Database (NIS) was used for our analysis. Patients in the year 2020 with an ICD-10 diagnosis code for acute ischemic stroke and procedural code for MT were included with and without COVID-19. Odds ratios (OR) were calculated using a logistic regression model with age, sex, stroke location, Elixhauser comorbidity score, and other patient variables deemed clinically relevant as covariates.
Results Patients in the COVID-19 group were younger (64.3±14.4 vs 69.4±14.5 years, P<0.001), had a higher rate of inpatient mortality (22.4% vs 10.1%, P<0.001), and a longer length of stay (10 vs 6 days, P<0.001). Patients with COVID-19 had higher odds of death (OR 2.78, 95% CI 2.11 to 3.65) and lower odds of a routine discharge (OR 0.65, 95% CI 0.48 to 0.89). There was no difference in the odds of subsequent stroke and cerebral hemorrhage, but patients with COVID-19 had statistically significantly higher odds of respiratory failure, pulmonary embolism, deep vein thrombosis, myocardial infarction, acute kidney injury, and sepsis.
Conclusions Patients with LVOs undergoing MT within the 2020 NIS database had worse outcomes when co-diagnosed with COVID-19, likely due to non-neurological manifestations of COVID-19.
- COVID-19
- Stroke
- Thrombectomy
Data availability statement
The authors have full access to the data. All data are available from the Healthcare Cost and Utilization Project as part of the Agency for Healthcare Research and Quality, or by the authors upon reasonable request.
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Data availability statement
The authors have full access to the data. All data are available from the Healthcare Cost and Utilization Project as part of the Agency for Healthcare Research and Quality, or by the authors upon reasonable request.
Footnotes
Twitter @AbdelsalamMd, @Starke_neurosurgery
Contributors All authors significantly contributed to this manuscript. Concept and design: RMS, AA, EL, JDB, IR, MS. Data acquisition: EL, HF, VG, IR. Data analysis and interpretation: RMS, EL, IR, VG. Literature search: IR, TE, HF, VG. Drafting the first manuscript: IR, EL, HF, VG. Revision of the manuscript for important intellectual content: IR, TE, HF, EL, RMS, MS, JDB. Responsible for overall content as guarantor: IR. Approval of final manuscript for submission: All authors.
Funding RMS's research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and by National Institute of Health (R01NS111119-01A1) and (UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. RMS also has an unrestricted research grant from Medtronic.
Competing interests The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. RMS has consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo, and Cerenovus.
Provenance and peer review Not commissioned; externally peer reviewed.
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