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SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group

Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbi...

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Autores principales: Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph, Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, Zand, Ramin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957755/
https://www.ncbi.nlm.nih.gov/pubmed/33804307
http://dx.doi.org/10.3390/jcm10050931
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author Shahjouei, Shima
Anyaehie, Michelle
Koza, Eric
Tsivgoulis, Georgios
Naderi, Soheil
Mowla, Ashkan
Avula, Venkatesh
Vafaei Sadr, Alireza
Chaudhary, Durgesh
Farahmand, Ghasem
Griessenauer, Christoph
Azarpazhooh, Mahmoud Reza
Misra, Debdipto
Li, Jiang
Abedi, Vida
Zand, Ramin
author_facet Shahjouei, Shima
Anyaehie, Michelle
Koza, Eric
Tsivgoulis, Georgios
Naderi, Soheil
Mowla, Ashkan
Avula, Venkatesh
Vafaei Sadr, Alireza
Chaudhary, Durgesh
Farahmand, Ghasem
Griessenauer, Christoph
Azarpazhooh, Mahmoud Reza
Misra, Debdipto
Li, Jiang
Abedi, Vida
Zand, Ramin
author_sort Shahjouei, Shima
collection PubMed
description Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6–14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8–40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4–36.2) were associated with cardioembolic stroke. Conclusions. Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities.
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spelling pubmed-79577552021-03-16 SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group Shahjouei, Shima Anyaehie, Michelle Koza, Eric Tsivgoulis, Georgios Naderi, Soheil Mowla, Ashkan Avula, Venkatesh Vafaei Sadr, Alireza Chaudhary, Durgesh Farahmand, Ghasem Griessenauer, Christoph Azarpazhooh, Mahmoud Reza Misra, Debdipto Li, Jiang Abedi, Vida Zand, Ramin J Clin Med Article Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6–14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8–40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4–36.2) were associated with cardioembolic stroke. Conclusions. Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities. MDPI 2021-03-01 /pmc/articles/PMC7957755/ /pubmed/33804307 http://dx.doi.org/10.3390/jcm10050931 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shahjouei, Shima
Anyaehie, Michelle
Koza, Eric
Tsivgoulis, Georgios
Naderi, Soheil
Mowla, Ashkan
Avula, Venkatesh
Vafaei Sadr, Alireza
Chaudhary, Durgesh
Farahmand, Ghasem
Griessenauer, Christoph
Azarpazhooh, Mahmoud Reza
Misra, Debdipto
Li, Jiang
Abedi, Vida
Zand, Ramin
SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group
title SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group
title_full SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group
title_fullStr SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group
title_full_unstemmed SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group
title_short SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group
title_sort sars-cov-2 is a culprit for some, but not all acute ischemic strokes: a report from the multinational covid-19 stroke study group
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957755/
https://www.ncbi.nlm.nih.gov/pubmed/33804307
http://dx.doi.org/10.3390/jcm10050931
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