Ischemia modified albumin: is this marker of ischemia ready for prime time use?

present a continuum of disease ranging from unstable angina, associated with reversible myocardial cell injury, to ST-segment elevation myocardial infarction, associated with irreversible myocardial necrosis. The common pathophysiological feature of the ACS spectrum is the rupture or erosion of atheromatous plaque. A number of cardiac biomarkers have been described that detect different stages in the development of ACS. The use of these biomarkers can be divided into two categories: diagnosis and risk stratification. From a diagnostic standpoint, the aim is to try and develop biomarkers that identify patients with ACS, even when there is no evidence of myocyte necrosis. Patients with cardiac ischemia are at increased risk for subsequent coronary events but they may often be discharged because there is insufficient evidence to justify hospital admission. In cases with cardiac ischemia, rather than necrosis, it may be more difficult to confirm the diagnosis when the patient has acute chest pain, non-diagnostic electrocardiograms (ECG), and normal biomarkers for necrosis. This diagnostic target is still in its infancy and there is no “gold standard” for accurately assessing myocardial ischemia. Although a number of new cardiac marker strategies (e.g. free fatty acids, choline)