Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: A Case-Control Study
Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: A Case-Control Study
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冠状病毒病 (COVID-19) 与大血管闭塞性脑卒中的关系： 病例对照研究
DOI：
10.2214/ajr.20.23847
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发表时间：
2021-01-01
影响因子：
5
通讯作者：
Belani, Puneet
中科院分区：
文献类型：
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作者：
Kihira, Shingo;Schefflein, Javin;Belani, Puneet
背景资料。在新冠肺炎大流行期间出现急性神经系统症状的患者中，观察到急性缺血性卒中的频率增加。目的：本研究的目的是在出现急性神经系统症状的患者中调查新冠肺炎与卒中亚型的相关性。方法：这项回顾性病例对照研究包括2020年3月16日至4月30日期间在纽约市六家医院中的任何一家属于单一医疗系统的中风代码被激活的患者。收集了人口统计学数据(年龄、性别和种族或民族)、新冠肺炎状况、中风相关危险因素以及与中风相关的临床和影像结果。结果：研究样本包括329名卒中代码被激活的患者(男性175例[53.2%]，女性154例[46.8%]；平均年龄66.9+/-14.9岁)。329例患者中，35.3%(116例)为急性缺血性卒中，21.6%(71例)为大血管闭塞(LVO)卒中，14.6%(48例)为小血管闭塞(SVO)卒中。在LVO卒中中，最常见的部位是大脑中动脉段M1和M2(62.0%[44/711])。多灶性LVO的发生率为9.9%(7/71)。38.3%(126/329)的患者出现新冠肺炎。61.7%(203/329)的非新冠肺炎患者为阴性对照组。在与中风相关的个体风险因素中，只有西班牙裔种族与新冠肺炎显著相关(患有新冠肺炎的患者中38.1%的患者与非新冠肺炎患者的20.7%相关；p=0.001)。31.7%的新冠肺炎患者存在左冠状动脉狭窄，而非新冠肺炎患者的这一比例为15.3%(p=0.001)。新冠肺炎组和非新冠肺炎组的室上性早搏发生率分别为15.9%和13.8%(p=0.632)。在对种族和民族进行控制的多因素分析中，与不存在新冠肺炎相比，存在新冠肺炎与左心室梗死有显著的独立关联(优势比2.4)，而不存在新冠肺炎(p=0.011)。结论：新冠肺炎与左心室梗死有关，但与室性早搏无关。出现急性神经系统症状的新冠肺炎患者有较低的怀疑大血管卒中的门槛，建议对大血管卒中立即进行检查。
BACKGROUND. An increase in frequency of acute ischemic strokes has been observed among patients presenting with acute neurologic symptoms during the coronavirus disease (COVID-19) pandemic.OBJECTIVE. The purpose of this study was to investigate the association between COVID-19 and stroke subtypes in patients presenting with acute neurologic symptoms.METHODS. This retrospective case-control study included patients for whom a code for stroke was activated from March 16 to April 30, 2020, at any of six New York City hospitals that are part of a single health system. Demographic data (age, sex, and race or ethnicity), COVID-19 status, stroke-related risk factors, and clinical and imaging findings pertaining to stroke were collected. Univariate and multivariate analyses were conducted to evaluate the association between COVID-19 and stroke subtypes.RESULTS. The study sample consisted of 329 patients for whom a code for stroke was activated (175 [53.2%] men, 154 [46.8%] women; mean age, 66.9 +/- 14.9 [SD] years). Among the 329 patients, 35.3% (116) had acute ischemic stroke confirmed with imaging; 21.6% (71) had large vessel occlusion (LVO) stroke; and 14.6% (48) had small vessel occlusion (SVO) stroke. Among LVO strokes, the most common location was middle cerebral artery segments M1 and M2 (62.0% [44/711]. Multifocal LVOs were present in 9.9% (7/71) of LVO strokes. COVID-19 was present in 38.3% (126/329) of the patients. The 61.7% (203/329) of patients without COVID-19 formed the negative control group. Among individual stroke-related risk factors, only Hispanic ethnicity was significantly associated with COVID-19 (38.1% of patients with COVID-19 vs 20.7% of patients without COVID-19; p = 0.001). LVO was present in 31.7% of patients with COVID-19 compared with 15.3% of patients without COVID-19 (p = 0.001). SVO was present in 15.9% of patients with COVID-19 and 13.8% of patients without COVID-19 (p = 0.632). In multivariate analysis controlled for race and ethnicity, presence of COVID-19 had a significant independent association with LVO stroke (odds ratio, 2.4) compared with absence of COVID-19 (p = 0.011).CONCLUSION. COVID-19 is associated with LVO strokes but not with SVO strokes.CLINICAL IMPACT. Patients with COVID-19 presenting with acute neurologic symptoms warrant a lower threshold for suspicion of large vessel stroke, and prompt workup for large vessel stroke is recommended.