For many years cardiac markers have been used to classify whether ches
t pain is attributable to acute myocardial infarction or not. However
massive, myocardial infarction is frequently preceded by plaque inflam
mation and local thrombus formation. Novel cardiac markers focus on de
tection of these more subtle manifestations of coronary artery disease
. Detection of inflammation of coronary artery plaques is best achieve
d by measurement of C-reactive protein and fibrinogen, while thrombus
formation may be assessed by testing for fibrin formation and platelet
activation. When coronary flow is severely impaired minor myocardial
injury will occur and cellular constituents may egress from damaged my
ocytes. Among the many cardiac markers for myocardial cell necrosis, t
roponin T revealed the highest sensitivity and cardio-specificity. The
superior performance of troponin T has not only refined detection of
myocardial cell necrosis but has also improved the risk stratification
process and may even facilitate therapeutic descision making in patie
nts with acute coronary syndrome. This review will summarize the chara
cteristics and performance of diagnostic tools used for classification
and risk stratification of patients with suspected myocardial injury.