The Ischemia Modified Albumin In Diagnosing Ischemic New Events

• Patients with primary complaints of chest discomfort or patients with symptoms indicative of a moderate to high probability for unstable angina clinically indicated reason for evaluation for ACS in the Emergency Department meeting tyhe following inclusion criteria will be enrolled:
• Age >=21 years
• Presentation within two hours of relief of most recent episode of chest pain or presence of on-going symptoms suggestive of coronary ischemia, which should be at least 10 minutes in duration.
• Patients being evaluated for suspected ischemic signs and or symptoms (chest pain) at the time of presentation according to routine standard of care institutional chest pain protocol/pathway.

Exclusion Criteria:

• Administration of thrombolytic medication prior to first (presentation) blood draw
• Acute coronary syndrome (ACS) secondary to supply/demand inequity (i.e. known anemia, tachycardia, - defined as HR greater than 150 bpm, known sepsis, hypotension, defined as blood pressure \< 90 mmHg).
• Established diagnosis of liver cirrhosis
• Other acute ischemic sources (ongoing severe claudication, mesenteric ischemia, acute TIA/CVA)
• Renal failure requiring dialysis
• Greater than 2 hours from relief of the most recent episode of chest pain or signs and symptoms suggestive of coronary ischemia.
• Chest pain following traumatic injury to the chest
• Evidence for sever systemic infection, manifesting as fever (temperature >100 degrees) and systolic blood pressure \<100 mmHg
• Patients unwilling or unable to provide written consent, without available next of kin
• Cocaine-related chest pain
• Pregnancy
• Known diagnosis of active malignancy
• Acute Bowel Ischemia
• Severe peripheral vascular disease
• Acute brain ischemia