Abstract TP185: Application of TOAST Criteria, Comorbidities and Outcomes in Patients with Ischemic Stroke: Multicenter Collaboration in the Dominican Republic

Introduction: Stroke is the leading cause of neurological -related deaths in the Caribbean. The Dominican Republic amongst the highest stroke-related mortality rates in The Americas.We aim is to determine stroke etiologies, define common comorbidities and outcomes for stroke in the Dominican Republic utilizing TOAST (The Trial of Org 10172 in Acute Stroke Treatment) etiological classification. Methods: Multicenter retrospective study of ischemic stroke patients between January 2022 and October 2024 using the Registry of Stroke Care Quality (RES-Q). Statistical analyses included t-tests/ANOVA, Chi-square, logistic regression, and correlation. Results: Of 976 patients, 57% were male. Most strokes were undetermined etiology (54.8%), followed by large artery atherosclerosis (17.2%) and cardioembolism (16.5%). Cardioembolic strokes had the highest mean NIHSS (9), followed by large artery atherosclerosis and other determined etiologies (7). Stroke severity correlated with older age, HIV, atrial fibrillation/flutter, prior stroke, and heart failure (p<0.05). Large artery atherosclerosis was associated with prior stroke (OR=1.53) and oral hypoglycemic use (OR=1.58). Small vessel occlusion was associated with hyperlipidemia (OR=2.14). Cardioembolism was strongly associated with atrial fibrillation/flutter (OR=19.6), anticoagulation (OR=9.2), antihypertensives (OR=3.0), and statins (OR=2.0). Other determined etiologies had lower odds of hypertension and atrial fibrillation/flutter, and undetermined etiology had lower odds of atrial fibrillation/flutter and prior stroke (p<0.05). Reperfusion therapy was given to 162 patients (16.6%): 57% intravenous thrombolysis, 33% thrombectomy, 10% bridging. Middle cerebral artery occlusion was most common (61.7%). Inpatient rehabilitation was limited: 526 received physical therapy, 6 occupational, 14 speech therapy. Post-mRS scores were significantly higher across all subtypes (p<0.001), with the greatest increase in cardioembolism (+1.73). Conclusions: Most ischemic strokes had undetermined causes, with men most affected. Cardioembolic strokes showed higher NIHSS scores. Severity correlated with age, heart failure, and prior stroke. Limited rehab access highlights diagnostic and treatment gaps. Findings stress need for better workup, reperfusion, and rehab in the Dominican Republic and similar regions, serving as a baseline for targeted prevention.