The Role of Biomarkers and Clinical Prediction Tools in the Diagnosis of Acute Aortic Syndromes: A Literature-Based Review.

Acute aortic syndromes (AAS) include a spectrum of life-threatening conditions that pose considerable diagnostic challenges, particularly in emergency care settings. Clinical scores and circulating biomarkers have become essential in improving diagnostic accuracy, risk stratification, and guiding clinical decision-making. Tools such as the Aortic Dissection Detection Risk Score (ADD-RS) and the AORTAs score offer structured methods for identifying patients at elevated risk; however, their diagnostic performance can be further enhanced through integration with biomarker testing and imaging modalities. Biomarkers including D-dimer, NT-proBNP, cardiac troponins, and novel candidates such as soluble ST2 (sST2) and matrix metalloproteinase-8 and 9 (MMP-8, MMP-9), have demonstrated potential in refining diagnostic and prognostic assessments with an outstanding sensibility. ADAMTS-1 and ADAMTS-4 appear to have the best diagnostic accuracy, whereas certain non-coding DNAs (miR-15a) achieve an exceptionally high negative predictive value. These biomarkers reflect key underlying mechanisms such as inflammation, oxidative stress, and vascular injury, offering valuable insights into disease severity and progression. However, limitations related to specificity, inter-cohort variability, and assay standardization currently hinder their widespread clinical adoption. Further validation through large-scale, multi-center studies is essential to establish their role within integrated diagnostic pathways.