Background : The utility of the standard biomarkers of myocardial necrosis for the confident exclusion of the diagnosis of myocardial ischemia at the presentation remains limited. Thus , markers for ischemia can serve an important role in diagnosis of early presenters of coronary artery diseases(CAD) and risk stratification for therapeutic aspect of those. A candidate marker for the detection of myocardial ischemia is ischemia modified albumin(IMA). Objectives : The aim of this study was to evaluate the role of IMA in diagnosis of early ischemia and risk stratification during diagnostic and therapeutic procedures in patients with suspected CAD. Subjects and Method: We enrolled consecutive 116 patients with CAD and suspected CAD(treadmil test; 52 patients, normal coronary angiography(CAG); 10 patients, percutaneous coronary intervention(PCI); 35 patients and coronary spasm positive study; 19 patients). Blood sampling for IMA was done in the baseline and within 1 hour after procedures . Results: The levels of IMA were changed during diagnostic and therapeutic procedures except normal coronary angiography(pre: 91.33 짹16.69 U/mL vs. post: 94.66짹18.96 U/mL, ns). IMA was decreased in the treadmill negative test(pre: 99.32 짹12.82 U/mL vs. post: 86.18짹15.21 U/mL, p<0.001), IMA were decreased in the treadmill positive test with horizontal ST segment depression (pre: 102.33 짹10.37 U/mL vs. post: 93.06짹16.89 U/mL, p=0.007) but elevated in treadmill positive test with ST segment elevation or downslope depression (pre: 99.33짹6.81 U/mL vs. post: 114.67짹9.61 U/mL, p=0.040), During other procedures, post levels of IMA were increased compared to baseline(prePCI : 109.11 짹14.35 U/mL vs. post: 127.89짹16.07 U/mL, p<0.001, preSpasm study : 106.84 짹11.49 U/mL vs. post: 119.68짹12.64 U/mL, p<0.001). Conclusions: IMA might serve a promising role in detection of early phase ischemia during diagnostic and therapeutic procedures of patients with acute coronary syndrome(ACS) and suspected CAD.