Ischemia-Modified Albumin and Conventional Cardiac Biomarkers in Myocardial Infarction: A Narrative Review

Acute myocardial infarction (AMI) requires prompt assessment using clinical findings, electrocardiography, and cardiac biomarkers.High-sensitivity cardiac troponin (hs-cTn) assays are central to current diagnostic pathways because they detect myocardial injury and support serial testing.This narrative review examines the proposed role of ischemia-modified albumin (IMA) alongside creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and cardiac troponins.IMA has been investigated as a potential early indicator of ischemia-associated changes in albumin metal-binding capacity.However, this biological rationale does not establish incremental diagnostic value beyond contemporary hs-cTn pathways, and limited cardiac specificity and variable assay performance restrict its clinical application.CK-MB has a more restricted potential role in selected circumstances, while LDH and AST have largely historical relevance as markers of MI because of their poor specificity.Evidence that adding IMA or older enzymes improves outcomes beyond contemporary troponin-based pathways remains insufficient.Further studies should evaluate these markers against current high-sensitivity troponin strategies using clearly defined patient populations and clinically relevant outcomes.