Diagnostics in patients with the acute coronary syndromes (ACS) is becoming even more complex with the increase of number of available options. In addition, the number of treatment options accessible to patients with ACS keeps on growing rapidly. Physicians must now choose from a wide variety of antiplatelet and antithrombotic therapies and also determine what patients would benefit from an invasive management approach. These decisions have become more difficult with the introduction of recent drugs such as low molecular weight heparins, direct-acting antithrombins, thienopyridines, and glycoprotein IIb/IIIa inhibitors. Simple tools, which can often be applied at the patient's bedside, can help physicians to choose the intensity of antiplatelet and antithrombotic therapy, and decide whether to use invasive coronary procedures. Cardiac biomarkers have proven to be particularly effective for these purposes. Moreover, cardiac biomarkers play an important role in risk stratification in ACS, and the results of cardiac biomarker tests can be used to help us choose between alternative therapies. In addition to biomarkers of myocyte necrosis, markers of neurohormonal activation, such as B-type natriuretic peptide (BNP), provide important prognostic information in ACS. However, the increase of number of elevated biomarkers, although simple to implement in practice, does not allow for full employment of value of information provided by these biomarkers. In the future, multimarker strategies that incorporate panels of cardiac biomarkers are likely to be used for risk stratification and for pathophysiology guided treatment in patients with ACS.