Complicaciones cardiovasculares de un paciente con Síndrome de Marfan y prolapso de válvula mitral. Revisión de la literatura.

Background: Marfan syndrome (MS) is a disorder that affects connective tissue and is associated with abnormalities of the musculoskeletal system. Among the complications that can be triggered by MS, cardiovascular anomalies that lead to unfavorable outcomes such as mitral valve prolapse (MVP) must be taken into account. MVP in patients with MS can trigger subsequent complications, such as mitral regurgitation and heart failure. Objective: Identify the cardiovascular complications of a patient with Marfan syndrome and mitral valve prolapse. Materials and methods: Systematized search of the literature in Medline, through PubMed, using the guidelines of the PRISMA Declaration for the selection of published studies. Results: Based on the 17 publications obtained in the systematized literature search process, the cardiovascular complications described were mitral regurgitation, mitral valve dysfunction, mitral valve replacement, infective endocarditis, dilatation of cavities and large vessels, heart failure, aortic dissection, reduced life expectancy, death, among others. Conclusions: MVP in patients with MS is one of the most important cardiovascular anomalies that lead to various cardiovascular complications, the main ones being mitral regurgitation and heart failure. For this reason, it is essential to recognize this relationship in order to prevent their development in time.Introducción: El síndrome de Marfan (SM) es un trastorno que afecta el tejido conectivo y se asocia a anomalías del sistema músculo-esquelético. Dentro de las complicaciones que se pueden desencadenar por el SM, se deben tener en cuenta las anomalías cardiovasculares que conlleva a desenlaces desfavorables como el prolapso de la válvula mitral (PVM). El PVM en pacientes con SM puede generar complicaciones posteriores, como la insuficiencia mitral y la insuficiencia cardiaca. Objetivo: Identificar las complicaciones cardiovasculares de un paciente con Síndrome de Marfan y prolapso de válvula mitral.Materiales y métodos: Búsqueda sistematizada de la literatura en Medline, a través de PubMed, utilizando las pautas de la Declaración PRISMA para la selección de estudios publicados. Resultados: Basándose en las 17 publicaciones obtenidas en el proceso de búsqueda sistematizada de la literatura, las complicaciones cardiovasculares descritas fueron insuficiencia mitral, disfunción de la válvula mitral, reemplazo de la válvula mitral, endocarditis infecciosa, dilatación de cavidades y grandes vasos, insuficiencia cardiaca, disección aórtica, esperanza de vida reducida, muerte, entre otras. Conclusiones: El PVM en pacientes con SM es una de las anomalías cardiovasculares más importantes que conllevan a diversas complicaciones cardiovasculares, siendo las principales la insuficiencia mitral y la insuficiencia cardiaca. Por esta razón, es indispensable reconocer esta relación para así prevenir a tiempo el desarrollo de las mismas

Complicaciones cardiovasculares en pacientes con Lupus Eritematoso Sistémico, de acuerdo a la fisiopatología de la enfermedad: Revisión de la literatura

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect any system of the individual's body, developing a wide variety of clinical manifestations. Each patient varies in the presentation of the disease, delaying their diagnosis and management. The main cause of death in these patients is caused by cardiovascular complications, such as stroke and myocardial infarction. Objective: To identify the cardiovascular complications that can develop in patients with SLE, according to the pathophysiology of the disease. Method: A systematic search of the literature in Medline was carried out using the guidelines of the PRISMA Declaration for the selection of published studies, using the terms "Systemic lupus erythematosus" and "cardiovascular disease". Results: Taking into account the 30 publications obtained in the systematic search of the literature, 24 demonstrated the presence of a relationship between SLE and the development of cardiovascular complications. These complications include atherosclerosis, stroke, peripheral vascular disease, myocarditis, among others, the most common being stroke, myocardial infarction, and atherosclerosis. Conclusions: SLE is a pathology involving several body systems, most commonly presenting with constitutional, mucocutaneous and musculoskeletal symptoms. However, it is essential to recognize the cardiovascular complications that can develop from this inflammatory pathology as well. This way, it is possible to reach an opportune diagnosis and provide better management, to reduce mortality from this cause.Introducción: El lupus eritematoso sistémico (LES) es una enfermedad autoinmune que puede afectar cualquier sistema del cuerpo del individuo, desarrollando una gran variedad de manifestaciones clínicas. Cada paciente varía en la presentación de la enfermedad, dificultando y retrasando el diagnóstico y su manejo. La principal causa de muerte en estos pacientes es dada por las complicaciones cardiovasculares, como el accidente cerebrovascular (ACV) y el infarto de miocardio. Objetivo: Identificar las complicaciones cardiovasculares que se pueden desarrollar en pacientes con LES, de acuerdo con la fisiopatología propia de la enfermedad. Método: Se realizó una búsqueda sistematizada de la literatura en Medline utilizando las pautas de la Declaración PRISMA para la selección de estudios publicados, utilizando los términos “Systemic lupus erythematosus” y “cardiovascular disease”. Resultados: Teniendo en cuenta las 30 publicaciones obtenidas en la búsqueda sistematizada de la literatura, 24 demostraron la presencia de una relación entre el LES y el desarrollo de complicaciones cardiovasculares. Estas complicaciones incluyen aterosclerosis, ACV, enfermedad vascular periférica, miocarditis, entre otras, siendo las más comunes el ACV, el infarto de miocardio y la aterosclerosis. Conclusiones: El LES es una patología que compromete varios sistemas del cuerpo, presentándose más comúnmente con síntomas constitucionales, mucocutáneos y músculo-esqueléticos. Sin embargo, es esencial reconocer las complicaciones cardiovasculares que pueden desarrollarse a partir de esta patología inflamatoria. De esta manera, se puede llegar a un diagnóstico oportuno y proporcionar un mejor manejo, para disminuir la mortalidad por esta causa

Sex and Gender Differences in Acute Stroke Care: Metrics, Access to Treatment and Outcome. A Territorial Analysis of the Stroke Code System of Catalonia

INTRODUCTION: Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. PATIENTS AND METHODS: Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. RESULTS: A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, DISCUSSION AND CONCLUSION: We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself

Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry

Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score 85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups' criteria). Results Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors

The Research Journey as a Challenge Towards New Trends

The academic community of the department of Risaralda, in its permanent interest in evidencing the results of the research processes that are carried out from the Higher Education Institutions and as a product of the VI meeting of researchers of the department of Risaralda held in November 2021 presents its work: “The journey of research as a challenge towards new trends”, which reflects the result of the latest research and advances in different lines of knowledge in Agricultural Sciences, Health Sciences, Social Sciences and Technology and Information Sciences, which seek to solve and meet the demands of the different sectors. This work would not have been possible without the help of each of the teachers, researchers and authors who presented their articles that make up each of the chapters of the book, to them our gratitude for their commitment, dedication and commitment, since their sole purpose is to contribute from the academy and science to scientific and technological development in the search for the solution of problems and thus contribute to transform the reality of our society and communities. We also wish to extend our gratitude to the institutions of the Network that made this publication possible: UTP, UCP, UNAD, UNIREMINGTON; UNISARC, CIAF, Universidad Libre, Uniclaretiana, Fundación Universitaria Comfamiliar and UNIMINUTO, institutions that in one way or another allowed this work to become a reality, which we hope will be of interest to you.Preface............................................................................................................................7 Chapter 1. Technologies and Engineering Towards a humanization in Engineering using soft skills in training in Engineers.............................................................................................................11 Omar Iván Trejos Buriticá1, Luis Eduardo Muñoz Guerrero Innovative materials in construction: review from a bibliometric analysis....................................................................................................................27 Cristian Osorio Gómez, Daniel Aristizábal Torres, Alejandro Alzate Buitrago, Cristhian Camilo Amariles López Bibliometric review of disaster risk management: progress, trends, and challenges.........................................................................................................51 Alejandro Alzate Buitrago, Gloria Milena Molina Vinasco. Incidence of land coverage and geology, in the unstability of lands of the micro-basin of the Combia creek, Pereira, Risaralda....................................73 Alejandro Alzate Buitrago, Daniel Aristizábal Torres. Chapter 2. Arts, Humanities, and Social Sciences Training experience with teachers teaching mathematics using the inquiry methodology ...............................................................................................95 Vivian Libeth Uzuriaga López, Héctor Gerardo Sánchez Bedoya. Interpretation of the multiple representations of the fears associated to the boarding of limited visual patients in the elective I students’ written productions and low vision ...................................................................................113 Eliana Bermúdez Cardona, Ana María Agudelo Guevara, Caterine Villamarín Acosta. The relevance of local knowledge in social sciences............................................131 Alberto Antonio Berón Ospina, Isabel Cristina Castillo Quintero. Basic education students’ conceptions of conflict a view from the peace for the education....................................................................................................143 Astrid Milena Calderón Cárdenas,Carolina Aguirre Arias, Carolina Franco Ossa, Martha Cecilia Gutiérrez Giraldo, Orfa Buitrago. Comprehensive risk prevention in educational settings: an interdisciplinary and socio-educational approach ............................................................................163 Olga María Henao Trujillo, Claudia María López Ortiz. Chapter 3. Natural and Agricultural Sciences Physicochemical characterization of three substrates used in the deep bedding system in swine .......................................................................................175 Juan Manuel Sánchez Rubio, Andrés Felipe Arias Roldan, Jesús Arturo Rincón Sanz, Jaime Andrés Betancourt Vásquez. Periodic solutions in AFM models........................................................................187 Daniel Cortés Zapata, Alexander Gutiérrez Gutiérrez. Phenology in flower and fruit of Rubus glaucus benth. Cv. Thornless in Risaralda: elements for phytosanitary management .........................................199 Shirley Palacios Castro, Andrés Alfonso Patiño Martínez, James Montoya Lerma, Ricardo Flórez, Harry Josué Pérez. Socio-economic and technical characterization of the cultivation of avocado (Persea americana) in Risaralda..............................................................217 Andrés Alfonso Patiño Martínez, Kelly Saudith Castañez Poveda, Eliana Gómez Correa. Biosecurity management in backyard systems in Santa Rosa de Cabal, Risaralda................................................................................................................227 Julia Victoria Arredondo Botero, Jaiver Estiben Ocampo Jaramillo, Juan Sebastián Mera Vallejo, Álvaro de Jesús Aranzazu Hernández. CONTENTS Physical-chemical diagnosis of soils in hillside areas with predominance of Lulo CV. La Selva production system in the department of Risaralda.............241 Adriana Patricia Restrepo Gallón, María Paula Landinez Montes, Jimena Tobón López. Digestibility of three concentrates used in canine feeding....................................271 María Fernanda Mejía Silva, Valentina Noreña Sánchez, Gastón Adolfo Castaño Jiménez. Chapter 4. Economic, Administrative, and Accounting Sciences Financial inclusion in households from socioeconomic strata 1 and 2 in the city of Pereira ..................................................................................................285 Lindy Neth Perea Mosquera, Marlen Isabel Redondo Ramírez, Angélica Viviana Morales. Internal marketing strategies as a competitive advantage for the company Mobilautos SAS de Dosquebradas........................................................................303 Inés Montoya Sánchez, Sandra Patricia Viana Bolaños, Ana María Barrera Rodríguez. Uses of tourist marketing in the tourist sector of the municipality of Belén de Umbría, Risaralda.............................................................................................319 Ana María Barrera Rodríguez, Paola Andrea Echeverri Gutiérrez, María Camila Parra Buitrago, Paola Andrea Martín Muñoz, Angy Paola Ángel Vélez, Luisa Natalia Trejos Ospina. Territorial prospective of Risaralda department (Colombia), based on the SDGS...............................................................................................................333 Juan Guillermo Gil García, Samanta Londoño Velásquez. Chapter 5. Health and Sports Sciences Performance evaluation in times of pandemic. What do medical students think?.......................................................................................................353 Samuel Eduardo Trujillo Henao, Rodolfo A. Cabrales Vega, Germán Alberto Moreno Gómez. The relevance of the therapist’s self and self-reference in the training of psychologists.....................................................................................................371 Maria Paula Marmolejo Lozano, Mireya Ospina Botero. Habits related to oral health which influence lifestyle of elder people in a wellness center for the elderly in Pereira 2020. .............................................387 Isadora Blanco Pérez, Olga Patricia Ramírez Rodríguez, Ángela María Rincón Hurtado. Analysis of the suicide trend in the Coffee Region in Colombia during the years 2012-2018 ..............................................................................................405 Germán Alberto Moreno Gómez, Jennifer Nessim Salazar, Jairo Franco Londoño, Juan Carlos Medina Osorio. Hind limb long bone fractures in canines and felines...........................................419 María Camila Cruz Vélez, Valentina Herrera Morales, Alba Nydia Restrepo Jiménez, Lina Marcela Palomino, Gabriel Rodolfo Izquierdo Bravo. Prevalence of overweight and obesity in children in the rural and urban area of Risaralda....................................................................................................439 Angela María Álvarez López, Angela Liceth Pérez Rendón, Alejandro Gómez Rodas, Luis Enrique Isaza Velásquez. Chapter 6. Architecture, Design and Advertising The artisan crafts of Risaralda, characteristics, importance, and risks within the Colombian Coffee Cultural Landscape, CCCL....................................457 Yaffa Nahir Ivette Gómez Barrera, Javier Alfonso López Morales

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. METHODS: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. FINDINGS: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. INTERPRETATION: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. FUNDING: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamentos de Atlántico y Cesar

No aplicaLa violencia en Colombia ha dejado un rastro de dolor, por hechos presentados, por la disputa del poder, dejando muertos; y que por medio de las narrativas los campesinos construyen el tejido social. Este trabajo inicia con el análisis de los Relatos de Historias del caso de Ernesto, una narración que surge de los actos violentos y desaparición de la tía, ligado a la fractura familiar por el trabajo en la comunidad, siendo exiliados a otro país, para guardar la vida, pero que a través de las memorias y los significados de violencia vuelve para contar la verdad. Desde allí se encontraron emergentes psicosociales, la posición como víctima o sobreviviente, significados de violencia, recursos de afrontamiento y resiliencia, como la articulación de preguntas circulares, reflexivas y estratégicas para construir la sanación de “sí mismo”. También se realiza el análisis del caso de El Salado, una masacre de los grupos paramilitares, manifestado emergentes psicosociales afectando lo físico, psicológico y emocional, impactos bio-psico-socio-cultural, los significados de resiliencia y transformación, en el quehacer como psicólogo en el contexto de violencia con estrategias de intervención psicosocial. Posteriormente se encuentra el análisis y reflexión de la experiencia realizada del paso 3, presentando la foto voz como herramienta para expresar los significados de violencia como una alternativa de sanación a la no repetición. Por último, se concluye que a través del enfoque narrativo se plantean los medios para enfrentar los impactos psicosociales que causan dolor por los acontecimientos que traumatizan al individuo en los contextos de violencia.The violence in Colombia has left a trail of pain, due to facts presented, due to the dispute of power, leaving dead; and that through narratives peasants build the social fabric. This work begins with the analysis of the Stories of Ernesto's case, a narrative that arises from the violent acts and disappearance of the aunt, linked to the family fracture due to work in the community, being exiled to another country, to save their lives, but that through memories and meanings of violence returns to tell the truth. From there, psychosocial emergents were found, the position as a victim or survivor, meanings of violence, coping resources and resilience, such as the articulation of circular, reflective and strategic questions to build the healing of "oneself". The analysis of the case of El Salado, a massacre of paramilitary groups, manifested psychosocial emergents affecting the physical, psychological and emotional, bio-psycho-socio-cultural impacts, the meanings of resilience and transformation, in the work as a psychologist in the context of violence with psychosocial intervention strategies. Subsequently, there is the analysis and reflection of the experience carried out in step 3, presenting the voice photo as a tool to express the meanings of violence as a healing alternative to non-repetition. Finally, it is concluded that through the narrative approach, the means to face the psychosocial impacts that cause pain due to events that traumatize the individual in contexts of violence are proposed

Revista Temas Agrarios Volumen 26; Suplemento 1 de 2021

1st International and 2nd National Symposium of Agronomic Sciences: The rebirth of the scientific discussion space for the Colombian Agro.1 Simposio Intenacional y 2 Nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.

BACKGROUND AND OBJECTIVES COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19. METHODS Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis

Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry

BACKGROUND AND OBJECTIVES: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19. METHODS: Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis