Ischemia-modified albumin is the first biomarker for myocardial ischemia to be approved by the FDA. Other markers are being evaluated such as free fatty acids, pregnancy-associated plasma protein-A, glycogen phosphorylase isoenzyme BB, sphingosine-1-phosphate and whole blood choline. This area of clinical research will continue to grow, given the importance of detecting myocardial ischemia. Which marker or combination of markers will, ultimately, be the best approach awaits further research.