Aim: Role of the Trace Elements and Cardiac Markers in Assessment of Acute Coronary Syndromes. Methods: 150 adult patients were included in this study. 120 patients were suffering from ischemic heart disease (68 males and 52 females) with ages ranged from 44 to 66 years. 30 healthy individuals (20 males and 10 females) with ages ranged from 45 to 65 years, who served as a control group. The control group had no clinical evidence of coronary artery disease (CAD) or family history of CAD. All study participants were subjected to full history taking including Age, sex, socioeconomic status and occupations, smoking, history of Diabetes Mellitus, hypertension, coronary artery disease, ischemic heart disease and previous myocardial infarction. Results: The CK-MB levels were significantly increased in group II and group III (p< 0.001, =0.014), respectively as compared to control group. Also, group II was significantly higher than group I (p< 0.001). The AST levels were significantly increased in group III (p< 0.001) as compared to control group. Also, group III was significantly higher than group I, group II and group IV (p< 0.001). The Tn levels were significantly increased in group I, group II and group III (p=0.015, 0.007 and 0.001), respectively. There were significantly differences on comparing Tn levels among patients; group II and III were significantly higher than group I (p=0.007, 0.001 respectively), group I, group II and III (p=0.013, 0.004, < 0.001 respectively). No significant difference was found between group II and group III (p=0.884). No significant differences were found between patient groups and control group. Group II showed significantly lower iron level than group I (p=0.023). Also, group III showed significantly lower iron level than group I and group IV (p=0.013, 0.039 respectively). Serum zinc was significantly lower in group II than group I and group IV (p= 0.031, 0.003). No other significant correlation was observed. No significant correlation was obtained for the serum copper levels among the studied groups. The correlation between Fe, Zn and Cu versus Tn, CK and CK-MB in all studied groups were demonstrated in Table 6. There were significant positive correlation only between Fe versus Tn and CK-MB in group II (r=0.512, p=0.015), (r=0.506, p=0.016) respectively. There were significant negative correlation between Zn versus CK-MB in group I (r=-0.487, p=0.021). Otherwise no significant correlation were obtained between Zn versus Tn and CK in all studied groups and versus CK-MB in group II, group III, group IV and group V.There is no significant correlation were obtained between Cu versus Tn, CK, CK-MB in all studied groups. This cut-off values showed the highest accuracy to predict Fe usage (sensitivity of 77.47% and specificity of 72.69%), Cu usage (sensitivity of 84% and specificity of 87%) and Zn usage (sensitivity of 81% and specificity of 81%). Conclusion: We concluded that the Fe and Zn values were lower in ACS patients. Cu values did not show difference.