{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:24:33Z","timestamp":1787059473758,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Long-term prognosis after acute coronary syndrome (ACS) may reflect multidomain baseline characteristics. We evaluated outcome-independent mixed-data phenotypes and post hoc additive frameworks for all-cause mortality. Materials and Methods: Of 3801 consecutive patients hospitalized with ACS during 2017\u20132024, 3561 formed the survival cohort after 240 patients lacking mortality status or valid follow-up were excluded. Gower\u2013PAM phenomapping included 3491 patients after 70 patients with incomplete clustering variables were excluded. Cluster number was selected among k = 2\u20134 using prespecified outcome-independent silhouette, minimum-size, and bootstrap-stability criteria. AAR-3, CARE-4, and ACEF were compared in a common complete-case cohort of 3492 patients using an age-inclusive clinical reference model. Results: During a median follow-up of 3.35 years, 407 deaths occurred in the survival cohort. Three Gower\u2013PAM phenotypes were selected (average silhouette width, 0.417), with crude mortality proportions of 12.1%, 4.2%, and 19.2% in phenotypes A, B, and C, respectively (global log-rank p &lt; 0.001). The phenotype factor improved the primary age-inclusive model (joint p &lt; 0.001), although only phenotype B differed from phenotype A after adjustment. The joint phenotype effect was attenuated after expanded clinical adjustment (p = 0.673), and agreement with k-means sensitivity analyses was low. In the common cohort, the first-year adjusted HRs were 1.78 per 1-point increase in AAR-3 (95% CI, 1.46\u20132.19), 2.08 per 1-point increase in CARE-4 (95% CI, 1.76\u20132.46), and 2.66 per 1-unit increase in ACEF (95% CI, 2.14\u20133.30). The corresponding &gt;365-day landmark HRs were 1.56 (95% CI, 1.32\u20131.85), 1.66 (95% CI, 1.44\u20131.91), and 2.39 (95% CI, 1.95\u20132.92), respectively. Full-follow-up C-indices were 0.793 (95% CI, 0.772\u20130.814) with AAR-3, 0.815 (95% CI, 0.795\u20130.834) with CARE-4, and 0.812 (95% CI, 0.792\u20130.833) with ACEF, compared with 0.770 (95% CI, 0.747\u20130.792) for the age-inclusive reference model. None materially improved the model that already contained age, hemoglobin, eGFR, and LVEF continuously. Conclusions: Outcome-independent phenomapping identified exploratory, method-dependent patterns rather than ordered biological risk classes. The post hoc additive frameworks were internally associated with mortality but should not be regarded as validated prediction or treatment-directing tools. Prospective multicenter external validation is required before clinical application.<\/jats:p>","DOI":"10.3390\/medicina62081586","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T12:09:32Z","timestamp":1787054972000},"page":"1586","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploratory Mixed-Data Phenomapping and Risk-Enrichment Frameworks for Long-Term Mortality After Acute Coronary Syndrome: A Single-Center Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7261-8668","authenticated-orcid":false,"given":"Aykan","family":"\u00c7elik","sequence":"first","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U\u011fur","family":"Kocaba\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9793-718X","authenticated-orcid":false,"given":"Tuncay","family":"K\u0131r\u0131\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Efe","family":"Af\u015fin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6100-4050","authenticated-orcid":false,"given":"Harun","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elif Naz","family":"U\u00e7ak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Semih","family":"Babacan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Karaca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. 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