Difficulty in establishing a diagnosis of acute coronary syndrome (ACS) in the clinical setting has led researchers to investigate novel markers that show increased blood levels before the myocardial necrosis occurs. In ischemic conditions, some modifications occur in the amino acids located on the N-terminus of the human albumin molecule. Ischemia-modified albumin (IMA) is a marker formed after damage in the N-terminal region of albumin. The altered N-terminus can no longer bind transition metals, such as cobalt. The causes of the increases in IMA have been shown to be endothelial or extracellular hypoxia, acidosis, and free oxygen radicals. IMA, an early marker of ischemic disorders, is also a candidate marker for the detection of ACS. An assay measuring IMA might represent a promising marker for the identification of patients with myocardial ischemia. The aim of this study was to evaluate the clinical utility of IMA in the assessment of ACS as well as other medical disorders in light of the recent literature.