Context: Coronary artery disease (CAD) is the leading cause of death. Early detection of myocardial ischemia can decrease morbidity and mortality due to CAD. Ischemia modified albumin (IMA) is a newer biomarker for early detection of myocardial ischemia in patients of acute coronary syndrome (ACS) as compared to cardiac troponin T (cTnT). Aims: The aim of this study was to test the utility of “IMA,” a new biomarker of myocardial ischemia, in the early diagnosis of ACS. Settings and Design: The cross-sectional study group consisted of 101 patients between the age group of 27 and 85 years having ACS and 100 control from a healthy population. Materials and Methods: Blood was collected from all the enrolled patients immediately after admission, and samples were analyzed for cTnT on the fully automated analyzer and IMA on a spectrophotometer. Statistical Analysis Used: Statistical analysis was carried out by calculation of the area under a curve using receiver operating characteristics (ROC) curve analysis for the IMA test in the 101 patients included in the study population. Results: ROC curve area for IMA was 0.89 (95% confidence interval 0.81-0.94). At the cut-off 95 U/ml, sensitivity, and specificity were 85% and 82% and positive predictive value and negative predictive value (NPV) were 88% and 78%, respectively. Conclusions: IMA is a useful ischemic marker for diagnosis of myocardial ischemia due to high sensitivity, and it also facilitates to rule out myocardial ischemia due to high NPV.