Ischemia-Modified Albumin: Review of a Novel Cardiac Biomarker and Its Clinical Applications in Cardiovascular Disease

Ischemia-modified albumin (IMA) is a structurally altered form of human serum albumin produced within minutes of myocardial ischemia, well before the onset of irreversible cell injury detectable by cardiac troponin. Measured via the albumin cobalt-binding assay-the first Food and Drug Administration-approved serum marker for cardiac ischemia-IMA has been extensively investigated as an adjunct to electrocardiography and troponin for the early evaluation of acute chest pain in the emergency department. When used as part of a triple-test strategy combining IMA, troponin, and electrocardiogram, sensitivities exceeding 90-95% for acute coronary syndrome (ACS) exclusion have been reported, with 2 meta-analyses confirming significantly elevated IMA concentrations across ACS subtypes. Beyond diagnosis, IMA carries independent prognostic significance: elevated levels predict adverse outcomes at 1 year after acute myocardial infarction and correlate with the presence of critical coronary artery stenosis on angiography. IMA is not endorsed by current American College of Cardiology/American Heart Association guidelines for ACS evaluation, largely because of its low specificity and marked elevation in noncardiac conditions including pulmonary embolism, stroke, and heart failure. This review examines clinical evidence for IMA in cardiovascular disease, critically appraises its diagnostic limitations, and discusses its potential role as a complementary biomarker of ischemia-without-necrosis in the era of high-sensitivity troponin.