Stroke risk factors and outcomes in Trinidad and Tobago: The START study

Abstract

Abstract Introduction: This study aimed to assess the risk factors and outcomes of stroke and transient ischemic attacks (TIAs) at an academic tertiary medical center in Trinidad and Tobago. Methods This prospective cohort observational study evaluated 546 patients admitted with strokes and TIAs at the Eric Williams Medical Sciences Complex (EWMSC) from January 2023 to January 2024. Participants’ comorbidities, medications, and neuroimaging findings were recorded. Morbidity and survival outcomes utilizing the modified Rankin Scale (mRS) were assessed during their inpatient status and at three months post-hospitalization. Results The average age represented was 65 years, with 56% males. Seventy-five percent of patients had a stroke, with ischemic being more common than hemorrhagic. The in-hospital mortality rate was 16%, and the 3-month mortality rate was 26%. Gender was associated with an increased risk of having a stroke compared to a TIA (p-value 0.036). Chronic kidney disease (CKD) was associated with an increased odds of hemorrhagic stroke (p-value 0.02). Diabetes mellitus (DM) (p-value < 0.05), subarachnoid hemorrhage (SAH) (p-value < 0.05), intraparenchymal hemorrhage (IPH) (p-value < 0.001) and middle cerebral artery (MCA) infarct (p-value < 0.001) were predictors of in-hospital and 3-month mortality. Atrial fibrillation (AF) (p-value 0.031) was a predictor of in-hospital mortality. Age (p-value 0.004), heart failure with reduced ejection fraction (HFrEF) (p-value 0.032) and anterior cerebral artery (ACA) infarct (p-value < 0.001) were predictors of 3-month mortality. Age was positively correlated with mRS (p-value 0.013). Ischemic stroke had a median mRS of 3, while hemorrhagic stroke had a median mRS of 5 (p-value < 0.001). Conclusion This study demonstrated high-risk subgroups, morbidity and mortality outcomes in patients with stroke in Trinidad. Conventional risk factors such as age, CKD, DM, AF, and HFrEF with specific neuroradiologic findings (SAH, IPH, MCA and ACA infarcts) were all negative prognosticators with poor outcomes in stroke patients in Trinidad. This information may be clinically pertinent in devising comprehensive strategies to attenuate stroke burden. Further, large-scale prospective studies are required to confirm these epidemiologic results. Trial registration number: NCT05256550. This study was prospectively registered.