Background: Acute coronary syndrome (ACS) is accounting for any condition causing sudden reduced blood flow to the heart. Some trace elements play role in the development of ACS. Aim: This study aimed to evaluate the linkage between serum zinc, copper, iron level and cardiac markers in acute coronary syndromes. Methods: Eighty patients were divided into four groups. Group I (patients with unstable angina), Group II (acute myocardial infarction early 6 h), group III (acute myocardial infarction late 6 h) and group IV (patients with reperfusion therapy). Fifteen apparently healthy individuals served as a control group. Different risk factors as age, sex, diabetes and dyslipideamia were addressed in different groups. The correlation between Fe, Zn and Cu versus cardiac enzymes were demonstrated. The receiver operating characteristic (ROC) analysis was conducted. Results: Male and diabetic patients were significantly higher. The CK and Tn were significantly increased in groups I, II and III. The CK-MB levels were significantly increased in group II and group III. The AST levels were significantly increased in group III. The serum iron level was significantly lower in group I, II and III. Serum zinc show slight decrease in groups II and III. No significant correlation was obtained concerning serum Cu. In group II, there were significant positive correlation between Fe versus Tn, CK-MB and CK. The (ROC) analysis was identified the optimal Fe, Zn and Cu plasma level for potential prediction of development of ACS. Conclusion: Fe and Zn values were lower in ACS patients. Cu values did not show difference.