2019冠状病毒病急性缺血性卒中的静脉溶栓和血管内治疗：系统评价与荟萃分析
Intravenous thrombolysis and endovascular therapy for acute ischemic stroke in COVID-19: a systematic review and meta-analysis.
作者信息
Stuckart Isabella, Kabsha Ahmed, Siepmann Timo, Barlinn Kristian, Barlinn Jessica
机构信息
Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Division of Health Care Sciences, Center for Clinical Research and Management Education Dresden, Dresden International University, Dresden, Germany.
出版信息
Front Neurol. 2023 Aug 15;14:1239953. doi: 10.3389/fneur.2023.1239953. eCollection 2023.
BACKGROUND
The impact of COVID-19 on clinical outcomes in acute ischemic stroke patients receiving reperfusion therapy remains unclear. We therefore aimed to synthesize the available evidence to investigate the safety and short-term efficacy of reperfusion therapy in this patient population.
METHODS
We searched the electronic databases MEDLINE, Embase and Cochrane Library Reviews for randomized controlled trials and observational studies that investigated the use of intravenous thrombolysis, endovascular therapy, or a combination of both in acute ischemic stroke patients with laboratory-confirmed COVID-19, compared to controls. Our primary safety outcomes included any intracerebral hemorrhage (ICH), symptomatic ICH and all-cause in-hospital mortality. Short-term favorable functional outcomes were assessed at discharge and at 3 months. We calculated pooled risk ratios (RR) and 95% confidence intervals (CI) using DerSimonian and Laird random-effects model. Heterogeneity was evaluated using Cochran's Q test and statistics.
RESULTS
We included 11 studies with a total of 477 COVID-19 positive and 8,092 COVID-19 negative ischemic stroke patients who underwent reperfusion therapy. COVID-19 positive patients exhibited a significantly higher risk of experiencing any ICH (RR 1.54, 95% CI 1.16-2.05, < 0.001), while the nominally increased risk of symptomatic ICH in these patients did not reach statistical significance (RR 2.04, 95% CI 0.97-4.31; = 0.06). COVID-19 positive stroke patients also had a significantly higher in-hospital mortality compared to COVID-19 negative stroke patients (RR 2.78, 95% CI 2.15-3.59, < 0.001). Moreover, COVID-19 positive stroke patients were less likely to achieve a favorable functional outcome at discharge (RR 0.66, 95% CI 0.51-0.86, < 0.001) compared to COVID-19 negative patients, but this difference was not observed at 3-month follow-up (RR 0.64, 95% CI 0.14-2.91, = 0.56).
CONCLUSION
COVID-19 appears to have an adverse impact on acute ischemic stroke patients who undergo reperfusion therapy, leading to an elevated risk of any ICH, higher mortality and lower likelihood of favorable functional outcome.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42022309785.
背景
新型冠状病毒肺炎（COVID-19）对接受再灌注治疗的急性缺血性脑卒中患者临床结局的影响尚不清楚。因此，我们旨在综合现有证据，研究该患者群体再灌注治疗的安全性和短期疗效。
方法
我们检索了电子数据库MEDLINE、Embase和Cochrane图书馆综述，查找比较实验室确诊COVID-19的急性缺血性脑卒中患者与对照组使用静脉溶栓、血管内治疗或两者联合治疗的随机对照试验和观察性研究。我们的主要安全性结局包括任何颅内出血（ICH）、症状性ICH和全因住院死亡率。在出院时和3个月时评估短期良好功能结局。我们使用DerSimonian和Laird随机效应模型计算合并风险比（RR）和95%置信区间（CI）。使用Cochran's Q检验和I²统计量评估异质性。
结果
我们纳入了11项研究，共有477例COVID-19阳性和8092例COVID-19阴性缺血性脑卒中患者接受了再灌注治疗。COVID-19阳性患者发生任何ICH的风险显著更高（RR 1.54，95%CI 1.16-2.05，P<0.001），而这些患者症状性ICH风险名义上的增加未达到统计学意义（RR 2.04，95%CI 0.97-4.31；P=0.06）。与COVID-19阴性脑卒中患者相比，COVID-19阳性脑卒中患者的住院死亡率也显著更高（RR 2.78，95%CI 2.15-3.59，P<0.001）。此外，与COVID-19阴性患者相比，COVID-19阳性脑卒中患者出院时获得良好功能结局的可能性较小（RR 0.66，95%CI 0.51-0.86，P<0.001），但在3个月随访时未观察到这种差异（RR 0.64，95%CI 0.14-2.91，P=0.56）。
结论
COVID-19似乎对接受再灌注治疗的急性缺血性脑卒中患者有不利影响，导致任何ICH风险升高、死亡率更高以及获得良好功能结局的可能性更低。
系统评价注册
PROSPERO，标识符CRD42022309785。
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