Utility of the CHA₂DS₂-VASc score for predicting cerebral embolic events in patients with infective endocarditis

Aims: Cerebral embolic events (CEEs) are among the most serious complications of infective endocarditis (IE), yet risk stratification remains challenging in routine clinical practice. This study aimed to evaluate the utility of the CHA₂DS₂-VASc score in predicting CEEs during the active phase of IE, using a simple and accessible clinical tool. Methods: This retrospective single-center study included 158 patients with definite IE. CEEs were defined as ischemic stroke or transient ischemic attack confirmed by neuroimaging. The association between the CHA₂DS₂-VASc score and CEEs was assessed using logistic regression. Two models were constructed; model 1 (baseline clinical and echocardiographic variables) and model 2 (model 1+CHA₂DS₂-VASc). Model performance was evaluated using AUC, AIC, Nagelkerke R², Brier Score, calibration curve, and decision curve analysis. Results: CEEs occurred in 32 patients (20%). The CHA₂DS₂-VASc score was significantly higher in patients with CEEs (p=0.011) and remained an independent predictor in multivariate analysis (OR 3.00, 95% CI: 1.26-7.18, p=0.013). Incorporating the CHA₂DS₂-VASc score into the predictive model led to a substantial improvement in discrimination, increasing the AUC from 0.686 to 0.732. A threshold score of 2 provided optimal classification, demonstrating favorable sensitivity and specificity for identifying patients at risk of CEEs. Notably, the predictive value of the score remained robust across key subgroups, including those with left-sided IE, prosthetic material, atrial fibrillation, and preserved ejection fraction. Conclusion: The CHA₂DS₂-VASc score is a strong and independent predictor of CEEs in patients with IE. Its integration into clinical assessment may enhance embolic risk stratification, particularly during the active phase of the disease, and support timely decision-making in this high-risk population.