Acute aortic syndrome rule-out criteria: development and external validation.

The Acute Aortic Syndrome Rule-Out Criteria (ARC) identifies low-risk suspected acute aortic syndrome patients with 100% sensitivity in external cohorts, enabling safe rule-out without missing cases.

• Why it matters: Acute aortic syndrome is rare but often fatal when missed, and existing scores plus D-dimer still leave no sufficiently low-risk group to avoid further testing.
• What they did: ARC was derived from confirmed cases in the IRAD registry by adding predictors to reach sensitivity ≥ 99%, then externally validated in ADvISED, PROFUNDUS, and DAShED using sensitivity and specificity with 95% CIs.
• The result: ARC showed 99.2% sensitivity (95% CI 99.1-99.3) in derivation, 100% sensitivity with 23.7% specificity in ADvISED/PROFUNDUS (4598; 10.2% prevalence), and 100% sensitivity with 36.4% specificity in DAShED (5346; 0.3% prevalence), ruling out 36.3% without missing AAS cases.

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