Death from coronary artery disease is by far the leading cause of death worldwide. There is no doubt that a better understanding of atherothrombosis has guided development of improved diagnostic facilities as well as revascularization technologies in combination with current antithrombotic strategies that have altogether impressively reduced acute thromboembolic complications and death from cardiovascular causes within the last decades. However, the rate of ischemic complications even after optimal revascularization and medical therapy remains high. Similarly, morbidity and death associated with chronic ischemic heart disease and ischemic cardiomyopathy respectively are constantly rising. Therefore, there is still a strong need for effective primary prevention strategies, fast and accurate diagnostic procedures as well as for new and smart antithrombotic drugs. The review focuses on cardiac troponins, as relevant markers of myocardial necrosis, currently used in the diagnostic process of acute coronary syndrome. Furthermore, we will discuss the potential role of copeptin, a new marker of acute endogenous stress in acute coronary syndrome patients, as faster diagnosis might lead to faster treatment as well as improved short- and long-term outcome following acute coronary syndrome. Finally, platelets are an old, yet rediscovered biomarker for ischemic cardiovascular outcomes that might be used to estimate the individual bleeding or thrombotic risk and to tailor antiplatelet therapy.