Clinical and Imaging Phenotypes and Outcomes in a Costa Rican Cohort of Acute Ischemic Stroke Survivors: A Retrospective Study

Abstract

Background: We characterized clinical and imaging phenotypes and their association with clinical outcomes in acute ischemic stroke (AIS) survivors in the understudied region of Costa Rica. Methods: We conducted a retrospective cohort study in AIS patients treated at a tertiary stroke center in Costa Rica from 2011–2015. Participants underwent detailed phenotyping for cardiovascular risk factors and stroke etiology. We assessed the association of ischemic brain lesion features and clinical outcomes using the Oxfordshire Community Stroke Project (OCSP) classification. Results: We included 684 AIS survivors (60.2% males, aged 68.1 ± 13.6 years, mean ± SD). While the cardiovascular risk profiles and mortality rates of our patients were similar to populations in European and North American countries, only 20.2% of patients with atrial fibrillation (AF) received anticoagulation. On multivariable analysis, patients with total anterior circulation infarct (TACI) displayed an increased risk of complications (OR: 4.2; 95% CI: 2.2–7.8; p < 0.001), higher mortality (OR: 6.9; 95% CI: 2.9–16.1; p < 0.001) and lower chance of functional independence at discharge (OR: 8.9; 95% CI: 4.1–19; p < 0.001) compared to non-TACI. The comorbidity of bronchopneumonia increased the probability of death by 14.5 times. Conclusions: Our observations in a Costa Rican cohort of AIS survivors might help improve local measures for preventing and managing AIS.