The Ischemia Modified Albumin In Diagnosing Ischemic New Events

Inclusion Criteria: * 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