Cardiac markers are now considered as useful indexes for the diagnosis of myocardial ischemia and prediction of future events. Measurements of creatine kinase (CK) and MB enzymes have been considered as the gold standard in the past, but they lack sensitivity and specificity. Troponin has progressively gained acceptance as the new standard. Troponin assay is now widely available and several authors have demonstrated its diagnostic accuracy, predictive value, and capacity to predict prognosis and guide therapy in acute coronary artery disease. Further evaluations have however opened the perspective of more sensitive markers which may also exhibit more prompt elevation. B-type natriuretic peptide (BNP) is secreted during myocardial ischemia in response to increased overload pressure. BNP rises immediately after ischemic events and may be more sensitive than other cardiac markers, including troponin. Moreover, new techniques allow immediate determination. BNP therefore would be of great interest for the diagnosis and management of myocardial ischemia. New markers may allow determination of coronary plaque fissuring and detection of coronary disease at a preclinical phase.