[Phenotypic stratification of acute coronary syndrome patients based on metabolic and renal profiles: Prognostic insights from a hospital study].

Background

Acute coronary syndromes are characterized by substantial heterogeneity in clinical presentation and outcomes. Conventional prognostic scores are useful but may not fully capture the biological complexity of patient profiles.

Objective

To assess whether stratifying patients admitted for acute coronary syndrome according to metabolic, renal and inflammatory phenotypes provides additional prognostic information for in-hospital complications. PATIENTS AND

Methods

We conducted a hospital-based observational study including 134 patients admitted for acute coronary syndrome, 56% with non-ST-segment elevation myocardial infarction and 44% with ST-segment elevation myocardial infarction. Patients were classified into three phenotypic groups based on admission characteristics using latent class analysis: cardiorenal, metabolic and inflammatory. Associations with severity indices and in-hospital complications were analyzed.

Results

The metabolic phenotype was more often associated with non-ST-segment elevation presentation and a higher frequency of arrhythmic complications (P=0.024). The cardiorenal phenotype was associated with high mortality-risk score and in-hospital mortality (P=0.006). The inflammatory phenotype was associated with bleeding risk and hemodynamic instability (P<0.05). In multivariate analysis, adding phenotypes to conventional scores improved prognostic discrimination (incremental C-statistic improvement of 0.07; P=0.031).

Conclusion

Phenotypic stratification of patients with acute coronary syndrome refines risk assessment and identifies high-risk subgroups not fully captured by conventional scores. This approach may support more personalized in-hospital monitoring.