Fig. 1: Graphical overview of the study.

Steps A–C: Construction of patient-specific disease-frequency vectors by assembling the ICD-10 codes registered in the electronic health records. Using the date of the first CAG/CCTA as the index date, only ICD-10 codes registered before the index date are included. Steps D and E: Patient-specific vectors are embedded using SVD, and a patient similarity matrix is constructed from the cosine of the angle between the embedded vectors. Step F: Application of the MCL algorithm to obtain clusters of patients with specific patterns of multimorbidity. Step G: Characterization of the resulting clusters to examine their risk of three pre-defined outcomes and phenotypic characteristics defined from laboratory, medication and genetic data. CAG coronary angiography, CCTA coronary computed tomography angiography, ICD-10 International Statistical Classification of Diseases and Related Health Problems 10th Revision, IHD ischemic heart disease, MCL Markov Cluster, SVD singular value decomposition.