Risks of Stroke and Transient Cerebral Ischemia up to 4 Years Post-SARS-CoV-2 Infection in Large Diverse Urban Population in the Bronx

<b>Background:</b> SARS-CoV-2 infection could trigger hypercoagulation and hyperinflammation that may predispose patients to cerebrovascular events. The long-term risk of stroke among COVID-19 patients remains unclear. This study investigated the long-term risks of ischemic stroke and transient cerebral ischemia (TCI) among patients with and without COVID-19. <b>Methods:</b> We conducted an observational cohort study in the Montefiore Health System (February 2020-January 2024), with 52,117 COVID+ and 837,395 COVID- patients without prior cerebrovascular events. Demographics, comorbidities, insurance, unmet social needs, and median income were adjusted for using inverse probability weighting. Cox-proportional regression hazard ratios (HR) and their 95% confidence intervals were computed for ischemic stroke and TCI. <b>Results:</b> Compared to COVID- controls, ischemic stroke risk was higher among hospitalized COVID+ patients (HR = 1.32 [1.12-1.55]) and non-hospitalized COVID+ patients (1.21 [1.05-1.39]). Compared to COVID- controls, TCI risk was similar among hospitalized COVID+ patients (1.00 [0.75-1.33]), but higher among non-hospitalized COVID+ patients (2.15 [1.81-2.56]). <b>Conclusions:</b> Hospitalized and non-hospitalized COVID-19 patients had a higher long-term risk of ischemic stroke while only non-hospitalized COVID-19 patients had a higher long-term risk of TCI. These findings underscore the needs for long-term monitoring of cerebrovascular risk factors in COVID-19 survivors.