Significant Mortality Associated with COVID-19 and Comorbid Cerebrovascular Disease: A Quantitative Systematic Review

Tolga Sursal, Chirag D. Gandhi, Kevin Clare, Eric Feldstein, Ilya Frid, Martin Kefina, Daniela Galluzzo, Haris Kamal, Rolla Nuoman, Krishna Amuluru, Carrie R. Muh, Jared M. Pisapia, Edwin Gulko, Philip Overby, Dipak Chandy, Mill Etienne, Christeena Kurian, Gurmeen Kaur, Katarina Dakay, May AlhamidHosam Al-Jehani, Stephan A. Mayer, Fawaz Al-Mufti

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


We report the first quantitative systematic review of cerebrovascular disease in coronavirus disease 2019 (COVID-19) to provide occurrence rates and associated mortality. Through a comprehensive search of PubMed we identified 8 cohort studies, 5 case series, and 2 case reports of acute cerebrovascular disease in patients with confirmed COVID-19 diagnosis. Our first meta-analysis utilizing the identified publications focused on comorbid cerebrovascular disease in recovered and deceased patients with COVID-19. We performed 3 additional meta-analyses of proportions to produce point estimates of the mortality and incidence of acute cerebrovascular disease in COVID-19 patients. Patient's with COVID-19 who died were 12.6 times more likely to have a history of cerebrovascular disease. We estimated an occurrence rate of 2.6% (95% confidence interval, 1.2-5.4%) for acute cerebrovascular disease among consecutively admitted patients with COVID-19. While for those with severe COVID-19 we estimated an occurrence rate of 6.5% (95% confidence interval, 4.4-9.6%). Our analysis estimated a rate of 35.5% for in-hospital mortality among COVID-19 patients with concomitant acute cerebrovascular disease. This was consistent with a mortality rate of 34.0% which we obtained through an individual patient analysis of 47 patients derived from all available case reports and case series. COVID-19 patients with either acute or chronic cerebrovascular disease have a high mortality rate with higher occurrence of cerebrovascular disease in patients with severe COVID-19.

Original languageEnglish (US)
Pages (from-to)199-206
Number of pages8
JournalCardiology in review
Issue number4
StatePublished - Dec 29 2022


  • cerebrovascular
  • complications
  • COVID-19
  • meta-analysis
  • mortality
  • stroke
  • Cerebrovascular Disorders/epidemiology
  • SARS-CoV-2
  • COVID-19/complications
  • COVID-19 Testing
  • Humans
  • Risk Factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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