University of Toronto, Medicine, Division of Neurology, Toronto, Canada.
Hamilton Health Sciences, McMaster University, Medicine (Neurology), Hamilton, Canada.
Can J Neurol Sci. 2024 Jan;51(1):78-86. doi: 10.1017/cjn.2023.19. Epub 2023 Jan 30.
BACKGROUND & AIMS: It is unknown if the COVID-19 pandemic and public health measures had an immediate impact on stroke subtypes and etiologies in patients not infected with COVID-19. We aimed to evaluate if the proportion of non-COVID-19-related stroke subtypes (ischemic vs. hemorrhagic) and etiologies (cardioembolic, atherosclerosis, small vessel disease, and others) during the pandemic's first wave were different from prepandemic.
For this retrospective cohort study, we included patients without COVID-19 with ischemic or hemorrhagic stroke at two large Canadian stroke centers between March-May 2019 (prepandemic cohort) and March-May 2020 (pandemic cohort). Proportions of stroke subtypes and etiologies were compared between cohorts using chi-square tests.
The prepandemic cohort consisted of 234 stroke patients and the pandemic cohort of 207 stroke patients. There were no major differences in baseline characteristics. The proportions of ischemic versus hemorrhagic stroke were similar (ischemic stroke: 77% prepandemic vs. 75% pandemic; hemorrhagic stroke:12% prepandemic vs. 14% pandemic; > 0.05). There were no differences in etiologies, except for a decreased proportion of ischemic stroke due to atherosclerosis in the pandemic cohort (26% prepandemic vs. 15% pandemic; difference: 10.6%, 95%CI: 1.4-19.7; = 0.03). Notably, during the pandemic, the cause of ischemic stroke was more often unknown because of incomplete work-up (13.3% prepandemic vs. 28.2% pandemic, difference: 14.9%, 95%-CI: 5.7-24.2; = <0.01).
In this study, the pandemic had no clear effect on stroke subtypes and etiologies suggesting a limited impact of the pandemic on stroke triggers. However, the shift from atherosclerosis toward other causes warrants further exploration.
目前尚不清楚 COVID-19 大流行和公共卫生措施是否会对未感染 COVID-19 的患者的中风亚型和病因产生直接影响。我们旨在评估大流行第一波期间非 COVID-19 相关中风亚型（缺血性与出血性）和病因（心源性栓塞、动脉粥样硬化、小血管疾病等）的比例是否与大流行前不同。
本回顾性队列研究纳入了 2019 年 3 月至 5 月（大流行前队列）和 2020 年 3 月至 5 月（大流行队列）期间加拿大两家大型卒中中心的缺血性或出血性卒中患者，这些患者均未感染 COVID-19。使用卡方检验比较两个队列中风亚型和病因的比例。
大流行前队列包括 234 例卒中患者，大流行队列包括 207 例卒中患者。两组患者的基线特征无显著差异。缺血性与出血性卒中的比例相似（缺血性卒中：大流行前队列为 77%，大流行队列为 75%；出血性卒中：大流行前队列为 12%，大流行队列为 14%；>0.05）。病因方面没有差异，但大流行队列中缺血性卒中因动脉粥样硬化所致的比例降低（大流行前队列为 26%，大流行队列为 15%；差异：10.6%，95%CI：1.4-19.7；=0.03）。值得注意的是，大流行期间，由于检查不完整，缺血性卒中的病因更常无法确定（大流行前队列为 13.3%，大流行队列为 28.2%，差异：14.9%，95%CI：5.7-24.2；<0.01）。
本研究中，大流行对中风亚型和病因没有明显影响，表明大流行对中风诱因的影响有限。然而，从动脉粥样硬化向其他病因的转变值得进一步探讨。
