Abstract 181: Acute Ischemic Stroke And Endovascular Thrombectomy During COVID‐19 Pandemic: A Nationwide Analysis

Introduction COVID‐19 may be linked to higher rates of severe strokes and strokes in younger patients through distinct pathophysiological processes. Objectives To investigate characteristics and outcomes in COVID‐19 related acute ischemic stroke (AIS) and endovascular thrombectomy (EVT) in the 2020‐2021 National Inpatient Sample (NIS) database.MethodsNIS was queried for patients admitted in relation to AIS or who underwent EVT, stratifying patients based on COVID‐19 diagnosis. Demographics, co‐morbidities, and outcomes were compared between groups using univariate analyses. Propensity score matching was used for multivariable analyses. Primary outcomes were age difference and the difference in the prevalence of cardiovascular risk factors between the two groups. Secondary outcomes include rates of favorable hospital outcome, in‐hospital mortality, and the length of hospital stay. Results In the AIS cohort of 1,381,039 patients, 58,525 had COVID‐19. Mean age for COVID‐19 patients with AIS was lower (67.55 vs 69.40 years; SMD=0.134). There was a higher proportion of Black (21.1% vs 17.9%) and Hispanic patients (15.0% vs 8.5%) amongst COVID‐19 patients with AIS. In adjusted multivariable analyses, the presence of COVID‐19 in AIS patients was significantly associated with a higher rate of inpatient mortality (AOR:2.79; 95% CI[2.61‐2.98]; p<0.001) and a lower rate of favorable hospital outcome (AOR:0.66; 95% CI[0.62‐0.70]; p<0.001). 83,650 patients underwent EVT. 3,075 of these patients were diagnosed with COVID‐19. The COVID‐19 group in patients who underwent EVT presented with a younger average age (64.02 years vs 69.25 years; SMD=0.368) and a greater proportion of Black (19.0% vs 15.1%;SMD=0.277) and Hispanic patients (14.9% vs 8.4%; SMD=0.277). COVID‐19 in patients who underwent EVT was associated with higher in‐hospital mortality rate (AOR:2.21, 95% CI[1.65‐2.98], p<0.001). Conclusions This nationally representative analysis demonstrates patients with AIS and concomitant COVID‐19 infection were younger, with less cardiovascular risk factors, disproportionately Black and Hispanic, with worse neurological deficit and worse hospital outcome.