To compare the baseline risk factors, use of reperfusion therapies, and in-hospital outcomes of acute ischemic stroke (AIS) between patients with and without COVID-19 infection.

The effect of COVID-19 infection on the outcomes of AIS is unknown. 

Hospitalizations due to AIS with or without COVID-19 were identified from the Nationwide Inpatient Sample. Logistic/linear regression were used to compare the outcomes between the groups. 

There were 380,580 hospitalizations due to AIS from April to December 2020, of which 7,570 (2%) had COVID-19. Patients with COVID-19 were younger, more likely to be Black or Hispanic, had a lower prevalence of hypertension, hyperlipidemia, and tobacco use, and a higher prevalence of diabetes and congestive heart failure. Stroke severity, assessed using the Stroke Administrative Severity Index, was comparable between the two groups. Patients with COVID-19 were more likely to undergo mechanical thrombectomy (MT) (9.1% versus 6.5%, p<0.001), however, the rates of thrombolytic use were comparable to patients without COVID-19 (14.1% versus 12.6%, p 0.072). Patients with COVID-19 had higher in-hospital mortality [odds ratio (OR) 3.0, 95% confidence intervals (CI) 2.6-3.6] and were less likely to discharge to home (OR: 0.6, 95% CI: 0.5-0.7). They also had longer length of hospital stay and higher hospital charges. These differences remained significant even after adjustment for baseline differences and in the subgroup analyses of patients treated with thrombolytics or MT, except for the likelihood of discharge to home which was comparable between the groups among patients treated with MT.

In this nationwide analysis of AIS hospitalizations, patients with COVID-19 had a higher in-hospital mortality and worse discharge outcomes as compared to those without COVID-19 despite comparable stroke severity and comparable or higher rates of acute reperfusion therapies between the two groups. Future studies looking into the specific mechanisms of worse stroke outcomes in COVID-19 infection are needed.