Stroke Acute Management and Outcomes During the COVID-19 Outbreak: A Cohort Study From the Madrid Stroke Network. Issue 2 (February 2021)

• Record Type: Journal Article
• Authors: Fuentes, Blanca; Alonso de Leciñana, María; García-Madrona, Sebastián; Díaz-Otero, Fernando; Aguirre, Clara; Calleja, Patricia; Egido, José A.; Carneado-Ruiz, Joaquín; Ruiz-Ares, Gerardo; Rodríguez-Pardo, Jorge; Rodríguez-López, Ángela; Ximénez-Carrillo, Álvaro; de Felipe, Alicia; Ostos, Fernando; González-Ortega, Guillermo; Simal, Patricia; Gómez Escalonilla, Carlos I.; Gómez-Porro-Sánchez, Pablo; Desanvicente, Zayrho; Reig, Gemma; Gil-Núñez, Antonio; Masjuán, Jaime; Díez-Tejedor, Exuperio
• Is Part Of: Stroke. Volume 52:Issue 2(2021)
• Publication Date: 2021-02
• Subjects: COVID-19 -- hemorrhage -- pandemic -- patients -- reperfusion -- stroke, ischemic; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.120.031769
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose: The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non–COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19. Methods: Retrospective multicenter cohort study including consecutive acute stroke patients admitted to 7 stroke centers from February 25 to April 25, 2020 (first 2 months of the COVID-19 outbreak in Madrid). The quality of stroke care was measured by the number of admissions, recanalization treatments, and time metrics. The primary outcome was death or dependence at discharge. Results: A total of 550 acute stroke patients were admitted. A significant reduction in the number of admissions and secondary interhospital transfers was found. COVID-19 was confirmed in 105 (19.1%) patients, and a further 19 patients were managed as suspected COVID-19 (3.5%). No differences were found in the rates of reperfusion therapies in ischemic strokes (45.5% non–COVID-19, 35.7% confirmed COVID-19, and 40% suspected COVID-19; P =0.265). However, the COVID-19 group had longer median door-to-puncture time (110 versus 80 minutes), which was associated with the performance of chest computed tomography. Multivariate analysis confirmed poorer outcomes for confirmed or suspected COVID-19 (adjusted odds ratios, 2.05 [95% CI, 1.12–3.76] and 3.56 [95% CI, 1.15–11.05], respectively). Conclusions: This study confirms that patients with COVID-19 have more severe strokes and poorer outcomes despite similar acute management. A well-established stroke care network helps to diminish the impact of such an outbreak in stroke care, reducing secondary transfers and allowing maintenance of reperfusion therapies, with a minor impact on door-to-puncture times, which were longer in patients who underwent chest computed tomography. Abstract : Supplemental Digital Content is available in the text.