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Eight million patients with chest pain present annually to emergency departments (ED).1 Five million of this group are judged to have suspected acute coronary syndromes (ACS) and are admitted to the hospital. Less than half ultimately are found to have a cardiac diagnosis, causing costly, unnecessary admissions. Three million of this group are discharged from the ED each year, and 40,000 of these are inadvertently discharged as myocardial infarctions (MI). Mortality rates of missed diagnoses in patients sent home are 2-fold greater than those patients admitted. Thus, there is a considerable amount of clinical interest and research to identify markers of myocardial ischemia that could be monitored during the early, reversible stage of ACS to assist in the appropriate triage of patients presenting with symptoms suggestive of ACS. CE update [chemistry | molecular diagnostics] Ischemia Modified Albumin Measured by the Albumin Cobalt Binding Test: A Clinical and Analytical Review