Clinical and analytical review of ischemia-modified albumin measured by the albumin cobalt binding test.

IMA measured by the ACB test is proposed as a novel marker that appears sensitive to cardiac ischemia. It has the potential to become a triage tool in suspected ACS patients, especially to rule out ACS, and might also find utility in stroke, stress testing, nuclear imaging, and states of noncardiac ischemia and oxidative stress. Rapid-testing platforms will be necessary to achieve the optimal goal of assisting in the triage of chest (ACS) patients that present to EDs. However, it does not appear to be highly tissue or clinically specific. There is a continued need to improve the clinical and analytical evidence base of IMA to substantiate its clinical use in diagnostics and outcomes assessment. The search for a marker, whether IMA or another marker that establishes an evidence base, that would effectively rule in as well as rule out early cardiac ischemia continues. The ACB test has barely begun the exploration of the exciting challenges and discoveries that lie ahead in assisting clinicians in the early detection of myocardial ischemia to assist and improve patient triage, therapy, and management.