Abstract Details

Title The COVID-19 Pandemic Significantly Affected Acute Ischemic Stroke Subtype, Patient Characteristics, and Outcomes

Topic General Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-018

Objective To determine the composition of acute ischemic strokes (AIS) before and during the pandemic at a comprehensive stroke center in Colorado (USA).

Background The overall composition of stroke subtype is typically stable within biogeographical groups. Whether the COVID-19 pandemic impacted stroke etiology is still being investigated, but most studies have been performed outside the USA.

Design/Methods This retrospective cohort study of adults (≥18) with AIS evaluated stroke subtype using TOAST classification: 1) large artery atherosclerosis; 2) cardioembolic; 3) small vessel occlusion; 4) other known etiology; 5) cryptogenic stroke. Comparisons were made between the pre-COVID period (1/1/2019 – 12/31/2019) vs. the COVID period (3/1/2020 – 3/1/2021) using Pearson chi-square tests for stroke subtype, demographics (age, sex, race, comorbidities), stroke severity (NIHSS ≥21), and clinical outcome (discharge mRS ≥3).

Results There were 2,130 patients with AIS: Pre-COVID (n=1,034) and COVID (n=1,096). Patients admitted during the COVID period were significantly more likely to have cryptogenic strokes (25.6% vs. 31.8%, p=0.002) and less likely to have stroke subtypes of large artery atherosclerosis (17.6% vs. 12.1%, p<0.001) and small vessel occlusion (10.1% vs. 7.7%, p=0.05). There were no differences in the rate of cardioembolic stroke (36.2% vs. 35.7%, p=0.82) and other known etiology (10.4% vs. 12.7%, p=0.11) by time period. Patients admitted during the COVID period were more likely to be female (43.9% vs. 51.0%, p=0.001), have atrial fibrillation (17.2% vs. 21.2%, p=0.02), have more severe strokes (9.8% vs. 12.7%, p=0.01), and have worse outcomes compared to patients admitted pre-COVID (53.5% vs. 60.9%, p=0.003).

Conclusions In the setting of a widespread pandemic, stroke etiology, demographics, and clinical outcomes can shift dramatically. During COVID-19, these changes included more cryptogenic strokes, more strokes among females and patients with atrial fibrillation, more severe strokes, and worse outcomes. Whether there has been a lasting shift is currently being investigated.

Authors/Disclosures
Anna Belits, DO PRESENTER	Dr. Belits has nothing to disclose.
Ian Rankine, DO (HealthONE Neurology Residency)	Dr. Rankine has nothing to disclose.
Kristin Salottolo, MPH	Ms. Salottolo has nothing to disclose.
Katie Higgins, MD (HealthONE)	Dr. Higgins has nothing to disclose.
Frank Wang, DO	Dr. Wang has nothing to disclose.
DaYoung Kim, DO (HCA)	Dr. Kim has nothing to disclose.
Yasaman Pirahanchi, MD (Brigham and Women's Hospital)	Dr. Pirahanchi has nothing to disclose.
David Bar-Or	David Bar-Or has received intellectual property interests from a discovery or technology relating to health care.
Christian J. Burrell, MD (Blue Sky Neurology)	Dr. Burrell has nothing to disclose.

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