Acute chest pain is one of the most common causes of patient attendance in the emergency departments (EDs). Traditionally, the diagnosis of acute coronary syndromes (ACS) relies on the combination of typical chest pain, electrocardiographic (ECG) changes and serum markers elevation, such as Troponin-I and CK-MB isoenzyme. However, a large number of patients with myocardial ischemia remain undiagnosed. Ischemia-modified albumin (IMA) increases within minutes after the onset of ischemia and remains elevated for 6 to 12h. Aim: The aim of the present study was to review the literature, Greek and international, regarding the efficacy of IMA in the early diagnosis of myocardial ischemia. Methods: The methodology followed, included bibliography research from both review and research literature, through databases PubMed, Medline, Scopus and Embase, with the use of keywords, such as ischemia-modified albumin, myocardial ischemia, acute coronary syndromes, albumin cobalt-binding test. Complementary bibliography was found through other electronic search engines (Medscape, MedExplorer), and by reviewing references of already found articles. Data were collected between October 2008-January 2009 and the research was repeated from September to December 2010. Results: Research findings indicate that IMA can detect ischemia whether or not necrosis is present. Given the fact that IMA levels return to normal within 24h, the aforementioned marker may contribute decisively in risk stratification of acute chest pain patients. Due to its high negative predictive value (NPV) and its high sensitivity in detecting ACS may help in screening patients with chest pain. Unfortunately, IMA's high sensitivity comes at the expense of a lower specificity for the myocardial cell, since its increase may be due to ischemia of other tissues. This may increase the number of patients admitted, that do not have ischemia. Conclusion: A better understanding of IMA mechanism of action in the early stages of myocardial ischemia in patients with ACS is considered of great importance and further research in this direction is already ongoing (international multicentre IMAGINE trial).