Background: Misdiagnosis of acute aortic dissection (AAD) can lead to significant morbidity and death. Soluble ST2 (sST2) is a cardiovascular injury–related biomarker. The extent to which sST2 is elevated in AAD and whether sST2 can discriminate AAD from other causes of sudden-onset severe chest pain are unknown.

Methods: We measured plasma concentrations of sST2 (R&D Systems assay) in 1360 patients, including 1027 participants in the retrospective discovery set and 333 patients with initial suspicion of AAD enrolled in the prospective validation cohort. Measures of discrimination for differentiating AAD from other causes of chest pain were calculated.

Results: In the acute phase, sST2 levels were higher in patients with AAD than those with either acute myocardial infarction in the first case-control discovery set within 24 hours of symptom onset or with patients with pulmonary embolism in the second discovery set (medians of 129.2 ng/mL versus 14.7 with P<0.001 for AAD versus acute myocardial infarction and 88.6 versus 9.3 with P<0.001 for AAD versus pulmonary embolism). In the prospective validation set, sST2 was most elevated in patients with AAD (median [25th, 75th percentile]: 76.4 [49.6, 130.3]) and modestly elevated in acute myocardial infarction (25.0 [15.5, 37.2]), pulmonary embolism (14.9 [10.2, 30.1]), and angina patients (21.5 [13.1, 27.6], all P<0.001 versus AAD). The area under receiver operating characteristic curve for patients with AAD versus all control patients within 24 hours of presenting at the emergency department was 0.97 (0.95, 0.98) for sST2, 0.91 (0.88, 0.94) for D-dimer, and 0.50 (0.44, 0.56) for cardiac troponin I, respectively. At a cutoff level of 34.6 ng/mL, sST2 had a sensitivity of 99.1%, specificity of 84.9%, positive predictive value of 68.7%, negative predictive value of 99.7%, positive likelihood ratio of 6.6, and negative likelihood ratio of 0.01.

Conclusions: Among patients with suspected aortic dissection in the emergency department, sST2 showed superior overall diagnostic performance to D-dimer or cardiac troponin I. Additional study is needed to determine whether sST2 might be a useful rule-out marker for AAD in the emergency room.

背景：急性主动脉夹层（AAD）的误诊可导致明显的发病和死亡。可溶性ST2（sST2）是与心血管损伤相关的生物标志物。尚不清楚sST2在AAD中升高的程度以及sST2是否能够将AAD与突然发作的严重胸痛的其他原因区分开。

方法：我们在1360名患者中测量了sST2（R＆D系统测定）的血浆浓度，其中包括1027名回顾性发现集参与者和333名最初怀疑AAD的患者参加了前瞻性验证队列。计算了区分AAD和其他原因引起的胸痛的判别方法。

结果：在急性期，AAD患者的sST2水平高于症状发作后24小时内第一个病例对照发现组的急性心肌梗死患者或第二个发现组中患有肺栓塞的患者的sST2水平更高。对于急性心肌梗死，AAD为129.2 ng / mL，而P <0.001则为14.7 ng / mL ；对于肺动脉栓塞，AAD为8 < 8.6，而P <0.001则为9.3 。在前瞻性验证组中，AAD患者中sST2最高（中位[第25、75％]：76.4 [49.6、130.3]），在急性心肌梗塞（25.0 [15.5、37.2]），肺动脉栓塞（14.9）中适度升高[10.2，30.1]）和心绞痛患者（21.5 [13.1，27.6]，所有P与AAD相比，<0.001）。在急诊就诊的24小时内，AAD患者与所有对照患者的接受者操作特征曲线下面积的sST2为0.97（0.95，0.98），D-二聚体为0.91（0.88，0.94），0.50（0.44，心脏肌钙蛋白I分别为0.56）。截止浓度为34.6 ng / mL时，sST2的敏感性为99.1％，特异性为84.9％，阳性预测值为68.7％，阴性预测值为99.7％，阳性似然比为6.6，阴性似然比为0.01。

结论：在急诊室怀疑有主动脉夹层的患者中，sST2的总体诊断性能优于D-二聚体或心肌肌钙蛋白I。还需要进一步研究以确定sST2是否可能是急诊室AAD的有用排除指标。