Real-world characteristics and outcomes of ischemic stroke: a Peruvian multicenter analysis from the RES-Q registry

To characterize and compare clinical profiles, care times, and functional outcomes between thrombolyzed and non-thrombolyzed patients with acute ischemic stroke (IS) within the Peruvian healthcare system using real-world data from the RES-Q registry.

A retrospective multicenter cohort study was conducted. Data from adult patients with acute IS registered between January 2023 and June 2025 across five hospital centers in Peru (Lima, Arequipa, Cusco) were analyzed. The primary exposure was intravenous thrombolysis (IVT). Primary outcomes were functional independence [modified Rankin Scale (mRS) 0-2] at discharge, symptomatic intracranial hemorrhage (sICH), and in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of poor functional outcome and mortality.

Of 1,780 patients with IS, 252 (14.2%) received IVT. Despite presenting with more severe strokes (higher median NIHSS, p < 0.001), the IVT group had a significantly higher rate of functional independence at discharge (50.7% vs. 38.3%, p < 0.001). In multivariable analysis, IVT remained an independent predictor of good functional outcome (adjusted odds ratio for poor outcome: 1.30 for non-IVT group). The median door-to-needle time was 68 minutes. In-hospital mortality did not differ significantly between groups (7.14% vs. 5.76%, p = 0.389). Key independent predictors of poor functional outcome were higher NIHSS (aOR 1.20 per point, 95% CI 1.16-1.24, p < 0.001), age (aOR 1.01 per year, 95% CI 1.00-1.02, p = 0.017), and diabetes (aOR 1.45, 95% CI 1.05-1.99, p = 0.022). For mortality, significant predictors were NIHSS (aOR 1.25, 95% CI 1.19-1.32, p < 0.001) and diabetes (aOR 2.21, 95% CI 1.12-4.38, p = 0.022).

This real-world multicenter study in Peru demonstrates that IVT is feasible and effective, associating with significantly better functional outcomes despite treatment of a more severely affected cohort. The study validates the safety profile of IVT in this setting and identifies critical areas for quality improvement, particularly in reducing door-to-needle times and addressing disparities in access to mechanical thrombectomy. Our findings support the expansion and optimization of acute stroke reperfusion protocols in Peru and similar resource-limited healthcare systems.