Original article

Prognostic value of the CHA₂DS₂-VASc Score for cardiovascular mortality in NSTEMI patients with echocardiographic correlates

Authors

• • Minela Becirovic minela03@live.com Email Minela Becirovic. (compose email, opens in email app.) Minela Becirovic ORCID profile. (opens in new tab)
  • Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
• • Emir Becirovic Emir Becirovic ORCID profile. (opens in new tab)
  • Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
• • Amir Becirovic
  • Internal Medicine Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
• • Semir Hadzic
  • School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
• • Admir Abdic
  • Department of Surgery, Cantonal Hospital Bihać, Bihać, Bosnia and Herzegovina
• • Elma Mujaković Elma Mujaković ORCID profile. (opens in new tab)
  • Department of Anatomy, Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
• • Emir Begagić View profile of Emir Begagić. Emir Begagić ORCID profile. (opens in new tab)
  • Department of Neurosurgery, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
• • Kenana Ljuca Kenana Ljuca ORCID profile. (opens in new tab)
  • Department of Gynaecology and Obstetrics, University Clinical Centre Ljubljana, Ljubljana, Slovenia
• • Anesa Terzic
  • General Medicine, Health Centre Gračanica, Gračanica, Bosnia and Herzegovina
• • Ekrema Mujaric
  • Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
• • Nadina Ljuca
  • School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina

Abstract

Aim: To evaluate the prognostic value of the CHA₂DS₂-VASc score in relation to major adverse cardiovascular events (MACE) and cardiovascular mortality in patients with non-ST elevation myocardial infarction (NSTEMI), and to assess its association with clinical and echocardiographic characteristics.

Methods: This prospective, observational, cohort study included 311 NSTEMI patients admitted to the Internal Medicine Clinic at the University Clinical Centre Tuzla between January 2023 and April 2024. The patients were stratified into intermediate-risk (score < 4) and high-risk (score ≥ 4) groups based on the CHA₂DS₂-VASc score at admission. Demographic, clinical, and echocardiographic data were collected, including electrocardiography (ECG) and transthoracic echocardiography. All patients were followed for 3 months (90 days) to assess the occurrence of MACE and cardiovascular mortality.

Results: The patients in the high-risk group were older and had significantly lower left ventricular ejection fractions and larger left atrial diameters compared with the intermediate-risk group. During the 3-month follow-up, MACE occurred in 11.9% of high-risk and 3.9% of intermediate-risk patients; cardiovascular mortality was observed exclusively in the high-risk group (2.5%). A higher CHA₂DS₂-VASc score was significantly associated with cardiovascular mortality (p = 0.003), but not with overall MACE (p = 0.393). Moderate predictive accuracy for mortality (AUC = 0.64) and shorter event-free survival in the high-risk group (log-rank p = 0.005) were observed.

Conclusion: The CHA₂DS₂-VASc score showed potential as a simple and accessible tool for early identification of NSTEMI patients at risk of cardiovascular death. Its significant association with mortality supports its role as a supplementary risk stratification tool, although these findings require validation in larger, multicentre studies.

Keywords: CHA₂DS₂-VASc score, cardiovascular mortality, echocardiography, NSTEMI, risk stratification

How to Cite: Becirovic, M. , Becirovic, E. , Becirovic, A. , Hadzic, S. , Abdic, A. , Mujaković, E. , Begagić, E. , Ljuca, K. , Terzic, A. , Mujaric, E. & Ljuca, N. (2026) “Prognostic value of the CHA₂DS₂-VASc Score for cardiovascular mortality in NSTEMI patients with echocardiographic correlates”, Medicinski glasnik. 23(2). doi: https://doi.org/10.17392/medglas-2198-23-2