Multiple biomarkers have emerged as potentially useful in risk stratification of acute coronary syndrome ACS).Specifically, additional markers of vascular inflammation and oxidative stress may be helpful in the determination of clinical outcomes in patients that present to the hospital with ACS.In addition to traditional factors such as creatine kinase and troponin I, there is evidence to suggest that markers such as cytokines, choline, and isoprostanes may provide an additive predictive value to short and long term outcomes.In a single center study of 108 patients that presented to the hospital with ACS, we determined that free F2-isoprostane and choline were strongly predictive for 30 day cardiac events (including cardiac death, congestive heart failure, and ventricular arrhythrnias).C-reactive protein and interleukin-6 were not predictive.To determine the value of choline and F2-isoprostane in predicting 30 day cardiac events, receptor operator curves were performed.Choline and F2-isoprostane had a positive predictive value of 44% and 57%, respectively, and a negative predictive value of 89% and 90%, respectively.Our data suggest that a model that includes an array of biomarkers including troponin, choline, and free F2-isoprostane may be useful in predicting patients at higher risk of future events in ACS.