Background: Non–ST elevation myocardial infarction (NSTEMI) is an acute ischemic event causing cardiomyocyte death by necrosis in a clinical setting consistent with acute myocardial ischemia. Objective: The aim of the current study was to clarify relationship between left atrial remodeling especially LAVI and short term clinical outcome in patients with acute NSTEMI. Patients and methods: We conducted this study on 110 non-STEMI patients who were referred to Cardiology Department, Faculty of Medicine, Zagazig University. Echo was performed within 48 hours of non-STEMI and 3 months later. Data were collected and analyzed and patients were divided into 2 groups according to left atrial volume index (LAVI) after 3 months of non-STEMI using cut-off point 34 mL/m². Results: Ejection fraction after 3 months was lower among malone ante grade continence enema (MACE) group with statistically significant difference (p=0.023). Left atrial volume and left atrial volume index were higher among MACE group with statistically significant differences (p=0.0001; 0.0001). Percent of patients with LAVI>34 was higher among MACE group with statistically significant difference (p= 0.0008). Conclusion: left atrial volume index is a good predictor for incidence of major adverse cardiac events after non-STEMI especially heart failure and angina. At cutoff value equal to 34.2, LAVI exhibited 95.2% sensitivity and 83.2% specificity in predicting incidence of MACE. Determinants of LAVI was baseline left atrial volume, E/A ratio, lesions in left anterior descending and left circumflex artery and ejection fraction after 3 months of non STEMI.